Use of Clinical Audits to Evaluate Timing of Preoperative Antimicrobials in Equine Surgery at a Veterinary Teaching Hospital.
Authors: Ceriotti Serena, Westerfeld Roxane, Bonilla Alvaro G, Pang Daniel S J
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Preoperative Antimicrobial Timing in Equine Surgery Surgical site infections remain a significant concern in equine practice, and human guidelines recommend administering intravenous antimicrobials within 60 minutes of surgical incision to optimise prophylaxis. Researchers at a veterinary teaching hospital conducted two clinical audits before and after implementing policy changes around patient preparation and anaesthesia record-keeping, measuring the timing of antimicrobial administration relative to incision (tAB-INC), and examining how much time was lost during anaesthesia pre-induction and surgical preparation phases in both elective arthroscopies and emergency laparotomies. Emergency laparotomies achieved the 60-minute target more reliably than arthroscopies (median 45 and 53 minutes across the two audits), with significantly shorter surgical preparation times, though neither procedure type improved between audits despite policy changes. The proportion of arthroscopic procedures exceeding the 60-minute threshold correlated strongly with the number of joints being operated on (r = 0.77 and 0.59), highlighting a particular workflow bottleneck; antimicrobial documentation improved substantially for arthroscopies (82% to 97%) but remained incomplete overall. These findings underscore that meeting antimicrobial prophylaxis targets in equine surgery requires more than administrative changes—addressing the inherent time demands of multi-joint procedures and refining surgical protocols will be essential to reduce infection risk without compromising operative planning.
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Practical Takeaways
- •Current hospital protocols are failing to deliver antimicrobial prophylaxis within 60 minutes for arthroscopic procedures; review your pre-operative timeline and identify bottlenecks in surgical prep to close this gap
- •Multi-joint arthroscopies take significantly longer to prepare—plan your scheduling and antimicrobial administration accordingly, and consider pre-operative dosing strategies if pre-incision timing cannot be guaranteed
- •Documentation of antimicrobial administration is improving with focused policy attention; ensure your records are complete as audit cycles reveal compliance gaps
Key Findings
- •Laparotomies achieved median antimicrobial administration within 60 minutes of incision (45-53 min), but arthroscopies did not meet this target consistently
- •Surgical preparation time was significantly shorter for laparotomies than arthroscopies (p < 0.0001), with strong correlation between number of joints operated and preparation time (r = 0.59-0.77)
- •Antimicrobial recording completeness improved significantly for elective arthroscopies (82% to 97%, p = 0.008) but not for emergency laparotomies (76% to 88%, p = 0.2) following policy changes
- •Policy changes to anesthesia record-keeping and patient preparation did not reduce time to antimicrobial administration for arthroscopies, indicating need for additional interventions