Uygun Olmayan Cerrahi Antibiyotik Profilaksi Kullanımını ve Maliyetini Etkileyen Faktörler

Abstract

This study was carried out to determine the amount, causes and cost of surgical antibiotic prophylaxis (SAP) used in two public hospitals with and without a guide, according to the hospital SAP guidelines, and to investigate the factors that are effective in these uses. The population of the study, in which a retrospective, cross-sectional research design was used, comprised data of 5023 surgical procedures that were monitored at Yozgat City Hospital (YCH) and Gazi Mustafa Kemal State Hospital (GMKSH) between January 1, 2017 and December 31, 2018, and 61 surgeons working in these hospitals. Descriptive statistics, hypothesis testing, logistic and multiple linear regression analyzes were used in the analysis of the data. According to the guidelines in two hospitals, the general compliance rate found as 67.1% in the use of prophylactic antibiotics before surgery. The most common reasons for non-compliance are the long duration of SAP administration and the wrong choice of antibiotics. While the total amount of SAP consumption in the two hospitals is 60.3 DDD/100 patient days as defined daily dose (DDD), 17.7 DDD/100 patient days of this is due to inappropriate use. 34.1% of the total SAP cost is caused by inappropriate uses. While the rate of inappropriate SAP use was 19.5% in GMKSH with SAP guidelines, this rate was found to be 64.3% in YCH when SAP guidelines was not there. The increase in the rate of appropriate SAP use in YCH from 35.7% to 45.2% compared to the previous year shows that the guide has a positive effect. Not using a surgical technique, a procedure performed by general surgery, and being a group A3 and B procedure were found as common factors affecting inappropriateness of general SAP, SAP selection and duration, and the patient’s age was not found significant (p<0.05). Operation time, non-use of surgical technique, antibiotic type, type of service, being a group A3 and B procedure, being an emergency procedure, gender of the surgeon, experience of surgeon of more than 10 years, and inappropriate SAP duration are significant common predictors which also affect the total SAP cost and postoperative hospital stay (p<0.05).