Archives of Surgery February 22, 2005 Utilization of Antimicrobial Prophylaxis for Major Surgery: Baseline Results from the National Surgical Infection Prevention Project Dale W. Bratzler, DO, MPH  (Lead author) Oklahoma Foundation for Medical Quality, Inc. Hypothesis: Surgical site infections (SSIs) are a major contributor to patient injury, mortality and health care costs. Despite evidence of effectiveness to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. Objective: To describe the utilization of antimicrobial prophylaxis for Medicare patients undergoing major surgery. Design: National retrospective cohort study with medical record review. Setting: 2965 acute care hospitals throughout the United States. Patients: A systematic random sample of 34133 Medicare inpatients undergoing coronary artery bypass grafting, other open chest cardiac surgery (excluding transplant surgery), vascular surgery including aneurysm repair, thromboendarterectomy, and vein bypass operations, general abdominal colorectal surgery, hip and knee total joint arthroplasty (excluding revision surgery), and abdominal and vaginal hysterectomy during 2001. Main Outcome Measures: The proportion of patients who had parenteral antimicrobial prophylaxis initiated within one hour before the surgical incision; the proportion of patients who were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose prophylactic antimicrobial was discontinued within 24 hours of the end of surgery. Results: An antimicrobial dose was administered to 55.7% (95% CI, 54.8-56.6%) of patients within one hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% CI, 92.3-92.8%) of the patients. Antimicrobials were discontinued within 24 hours of surgery end time for only 40.7% (95% CI, 40.2-41.2%) of the patients. Conclusions: There are substantial opportunities to improve the utilization of prophylactic antimicrobials for patients undergoing major surgery.