改變外科手術預防性抗生素使用對經濟效益與術後傷口感染的影響：以闌尾切除術與腹式子宮切除術爲研究對象

Impacts of Clinical Pathways on Surgical Antibiotic Prophylaxis on Economic Benefits and Postoperative Wound Infections in Appendectomy and Abdominal Hysterectomy

林明鋒(Ming-Feng Lin) ； 賴姝惠(Shu-Hui Lai) ； 黃美鑾(Mei-Luan Huang)

《感染控制雜誌》 13卷3期 (2003/07) Pp. 130-138

https://doi.org/10.6526/ICJ.200307_13(3).0001

摘要

The purpose of this study was to evaluate the influence of setting up the policies on surgical antibiotic prophylaxis on economic benefits and postoperative wound infections. At our hospital, we changed the policy after a consensus meeting and revised clinical pathways for the appendectomy and the abdominal hysterectomy. The pre-intervention period was from July to December, 2001; and the post-intervention, from January to June, 2002. One hundred forty-nine patients receiving appendectomy, and 21 patients undergoing abdominal hysterectomy were included. The proportions of those receiving prophylactic antibiotics 30 minutes prior to incision in pre- and post-intervention period were: appendectomy, 22.9% vs. 93.6%; and abdominal hysterectomy, 57.1% vs. 85.7%. The rates of prophylactic antibiotic use within 24 hours in pre- and post-intervention period were: appendectomy, 1.4% vs. 91.0%; and abdominal hysterectomy, 14.3% vs. 100%. For appendectomy patients, the average hospital stay shortened 0.8 days after the intervention (p＜0.001). The average cost savings for the drugs and the total hospital bill were 50.3% (p＜0.001) and 7.4% (p=0.005), respectively. For the abdominal hysterectomy, the average hospital stay was 0.1 day longer after the intervention, not statistically significant (p=0.688); the cost savings were 62.0% (p＜0.001) for the drugs, and 11.2% (p=0.038) for the total hospital bill. During the study period, there were no infections in both types of surgeries either before or after the intervention. The study showed that setting up proper clinical pathways can dramatically increase the number of cases with appropriate timing in prophylactic antibiotic administration and decrease the hospital costs, without any change in the rate of post-operative infections.

關鍵字

預防性抗生素 ； 闌尾切除術 ； 子宮切除術 ； 傷口感染

並列摘要

The purpose of this study was to evaluate the influence of setting up the policies on surgical antibiotic prophylaxis on economic benefits and postoperative wound infections. At our hospital, we changed the policy after a consensus meeting and revised clinical pathways for the appendectomy and the abdominal hysterectomy. The pre-intervention period was from July to December, 2001; and the post-intervention, from January to June, 2002. One hundred forty-nine patients receiving appendectomy, and 21 patients undergoing abdominal hysterectomy were included. The proportions of those receiving prophylactic antibiotics 30 minutes prior to incision in pre- and post-intervention period were: appendectomy, 22.9% vs. 93.6%; and abdominal hysterectomy, 57.1% vs. 85.7%. The rates of prophylactic antibiotic use within 24 hours in pre- and post-intervention period were: appendectomy, 1.4% vs. 91.0%; and abdominal hysterectomy, 14.3% vs. 100%. For appendectomy patients, the average hospital stay shortened 0.8 days after the intervention (p＜0.001). The average cost savings for the drugs and the total hospital bill were 50.3% (p＜0.001) and 7.4% (p=0.005), respectively. For the abdominal hysterectomy, the average hospital stay was 0.1 day longer after the intervention, not statistically significant (p=0.688); the cost savings were 62.0% (p＜0.001) for the drugs, and 11.2% (p=0.038) for the total hospital bill. During the study period, there were no infections in both types of surgeries either before or after the intervention. The study showed that setting up proper clinical pathways can dramatically increase the number of cases with appropriate timing in prophylactic antibiotic administration and decrease the hospital costs, without any change in the rate of post-operative infections.

並列關鍵字

antibiotic prophylaxis ； appendectomy ； hysterectomy ； wound infection