Unwarranted Variability in Antibiotic Prophylaxis for Cesarean Section Delivery
Autor: | Ryan Joyce, Jennifer Friderici, Praveen Prasanna Md, Deborah Naglieri-Prescod, Nandakumar Ponnusamy Md, Neil Roy Connelly, Karthik Raghunathan |
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Rok vydání: | 2014 |
Předmět: |
medicine.medical_specialty
Standard of care Attitude of Health Personnel Process improvement Obstetrics and gynaecology Anesthesiology Pregnancy Physicians medicine Humans Multivariable model Antibiotic prophylaxis Intensive care medicine Cesarean Section business.industry Data Collection Antibiotic Prophylaxis United States Confidence interval Anesthesiology and Pain Medicine Hospital treatment Background current Emergency medicine Female Guideline Adherence business American society of anesthesiologists |
Zdroj: | Obstetric Anesthesia Digest. 34:86-87 |
ISSN: | 0275-665X |
Popis: | BACKGROUND Current guidelines from the American College of Obstetricians and Gynecologists recommend antibiotic prophylaxis for cesarean delivery immediately before incision. The purpose of this study was to measure and describe correlates of adherence to these guidelines in a sample of United States anesthesiologists. METHODS We invited a random sample of the membership of the American Society of Anesthesiologists (n = 10,000) to complete an online survey. RESULTS Of 1052 respondents (10.5%) with complete information for analysis, 63.5% (95% confidence interval 60.6%, 66.3%, n = 668) reported preincision prophylaxis as the standard of care for scheduled cesarean delivery. Twenty-eight percent (n = 299) agreed that the anesthesiologist should take primary responsibility for prophylaxis timing. In a multivariable model, significant variability in preincision prophylaxis was noted for hospital type (community versus teaching, 62% vs 70%, P = 0.004), region (West versus Southeast, 70% vs 59%, P = 0.01; West versus Southwest, 70% vs 58%, P = 0.02), and respondents' belief in appropriate preincision timing (those endorsing routine preincision administration [80%], routine after cord clamp administration [17%], at the discretion of the obstetrician [47%], and the belief that more information was needed [43%]) (P < 0.001 all comparisons). Respondents' belief about appropriate preincision timing was the strongest discriminator in the model (change in area under the receiver operating characteristic curve = 0.13 vs ≤0.02 for all others). CONCLUSION Adherence with current prophylactic antibiotic administration guidelines for cesarean delivery is not uniform. Education initiatives, regulatory maneuvers, and process improvement should be targeted at sites where anesthesiologists do not comply with current guidelines. |
Databáze: | OpenAIRE |
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