Postoperative Infection After Tibial Fracture and Long-term Clinical Outcomes: A Propensity-Matched Cohort Study

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Postoperative Infection After Tibial Fracture and Long-term Clinical Outcomes: A Propensity-Matched Cohort Study

Authors:
Lucineia Danielski

Body of Abstract:
BACKGROUND

Postoperative infection following tibial fracture fixation remains a major clinical challenge, yet its long-term consequences on bone healing, systemic complications, and survival are incompletely characterized at the population level. This study investigated the association between postoperative infection and adverse outcomes after tibial fracture.

METHODS

A retrospective cohort study was conducted using a large federated electronic health record network (2000–2025). Adult patients with tibial fractures treated operatively were classified into two cohorts: those who developed postoperative infection within 30 days of fixation and those without documented infection. Outcomes included osteomyelitis, fracture nonunion, all-cause mortality, systemic complications, sepsis, and hospital readmission, assessed at 1-, 5-, 10-, and 15-year follow-up windows starting 1 day after the index fracture. Propensity score matching (1:1) was performed to balance demographics and baseline comorbidities. Time-to-event analyses were estimated using Kaplan–Meier methods and Cox proportional hazards models.

RESULTS

Among over 45,000 eligible patients, 1,016 experienced postoperative infection. After propensity matching (n=892 per cohort), patients with infection demonstrated significantly higher long-term risks of osteomyelitis and fracture nonunion across all follow-up intervals. Infection was also associated with increased rates of systemic complications and sepsis, as well as persistently elevated hazards of all-cause mortality from 1 through 15 years of follow-up. Hospital readmissions occurred more frequently and repeatedly in the infected cohort. Survival analyses consistently showed worse outcomes among patients who developed postoperative infection, with increased hazard ratios across early and late follow-up periods.

CONCLUSIONS

Postoperative infection following tibial fracture fixation is associated with sustained long-term morbidity and mortality, including higher risks of osteomyelitis, nonunion, recurrent complications, sepsis, readmissions, and death extending up to 15 years after injury. These findings underscore the importance of aggressive infection prevention strategies and prolonged clinical surveillance in high-risk patients following tibial fracture surgery.

Temperature-Controlled Air Flow Ventilation maintains an ultra-clean operating room environment in a United States Hospital.

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Temperature-Controlled Air Flow Ventilation maintains an ultra-clean operating room environment in a United States Hospital.

Authors:
Jennifer Wagner

Body of Abstract:
Objective: The investigators sought to validate a Temperature controlled air flow (TcAF) system under routine conditions during live surgical cases in the United States. In-room testing of microbial contamination took place during three live orthopedic cases. Maximum and median concentration of microorganisms (CFU/m3) were reported at the sterile field, back instrument table(s) and in the periphery of the room where movement of personnel and equipment can increase airborne bioburden. 

Methods: The Environmental Quality Indicator (EQI) method was used to assess the airborne environment in both static conditions, and dynamic live orthopedic cases. EQIs measured included particle and microbial counts, velocity, humidity, temperature and air changes per hour (Figure 1). Other factors affecting surgical outcomes, such as door openings, number of personnel, duration of surgery, equipment presence and traffic patterns were recorded.

Setting: A fully functional and currently used operating room in an outpatient surgery center located in Rochester, New York. The OR was representative of a typical, modern, ASHRAE compliant orthopedic OR equipped with a TcAF system. The live cases in which the samples were collected, were representative of typical surgical cases routinely performed in the OR.

Results: The operating room maintained statistically significantly fewer bacterial counts (CFU/m3) in the sterile field (SF) sampling points compared to the back table (BT) sampling points. The operating room had a statistically significantly higher velocity within the TcAF system footprint compared to outside the footprint. The operating room maintained lower temperature and higher humidity levels within the footprint of the TcAF as compared to outside the footprint, statistically significantly fewer 0.5-micron size particle counts inside the TcAF footprint and back table (BT) sampling points, than outside the footprint, sterile field (SF) and 9-point (ISO 14644-1) sampling points. The operating room maintained statistically significantly fewer bacterial counts (CFU/m3) in the sterile field (SF) sampling points compared to the back table (BT) sampling points.

Conclusion: Temperature controlled Air Flow technology, commonly used in Europe, was effective at maintaining an ultra-clean operating room in the typically more chaotic US surgical culture. Uniform air flow directly over the sterile zones provides cleaner airborne environments. If the air delivery systems also include areas outside the sterile field, where surgical instruments, implants, and other surgical aides are placed, further reduction in bacterial contamination within critical aseptic zones will be achieved.

Postoperative Infection and Acute Pre-injury Alcohol Use Disorder in Hip Fracture Trauma Patients

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Postoperative Infection and Acute Pre-injury Alcohol Use Disorder in Hip Fracture Trauma Patients

Authors:
Jeffrey Liang, Newton Cao, Ashar Ata, Vishal Senthilkumar, Mitchell Rheeman, Marcel Tafen, Kurt Edwards, Amy Howk, Stephen Martone, Andrew Deroo, Samantha Thomas, Kinga Powers, Brian Nasca

Body of Abstract:
Background:
 Alcohol use disorder (AUD) is common among trauma patients and is associated with immune dysregulation and poor wound healing. The independent contribution of AUD to infectious complications after hip fracture surgery is not well characterized. We hypothesize that acute pre-injury alcohol use disorder (AAUD) increases the risk of postoperative infection(POI). This study aims to evaluate the association between AAUD and POI following hip fracture repair following trauma.

Methods:
 We conducted a retrospective cohort study of trauma patients using the 2023 TQIP database. AAUD was defined by a documented AUD history and a positive blood alcohol level higher ≥ 0.08. POI was defined as any infection occurring during hospitalization, including deep SSI, organ-space SSI, osteomyelitis, sepsis, and pneumonia. Bivariate analyses and logistic regression assessed associations between AAUD and infection, adjusting for age, sex, race, insurance, and injury severity score (ISS). Hospital-level factors, including trauma center level, and teaching status were evaluated. 

Results:
A total of 122,876 patients were included. Of that, 7,290(5.9%) patients fit the AAUD criteria.

Patients in the AAUD group were younger (mean age 64 vs 72 years) and were more frequently male (63% vs 35%). They were more likely to have public insurance (25% vs 15%), a higher ISS (11.6 vs 10.0). The AAUD cohort demonstrated markedly greater rates of smoking, cirrhosis, COPD, and composite mental illness, whereas the non-AAUD group had higher rates of diabetes, congestive heart failure, dementia, and hypertension (all p < 0.001). Overall POI occurred in 0.41% of patients and was significantly higher among those with AAUD (0.93% vs 0.38%; p < 0.001), younger age 18–30 (1.56% vs ≥70: ~0.30%; p < 0.001), male sex (0.61% vs 0.29%; p < 0.001), non-White race (Black: 0.96% vs White: 0.35%; p < 0.001), public insurance (0.66% vs 0.34%; p < 0.001), and higher ISS (18.0 vs 10.1; p < 0.001). AAUD patients also had increased respiratory complications (0.15% vs 0.08%), DVT (0.80% vs 0.46%), intubation (1.29% vs 0.72%), unplanned OR (1.06% vs 0.37%), alcohol withdrawal (5.34% vs 0.06%), ICU admission (17.9% vs 10.6%), and longer hospital stay (9.13 vs 7.41 days). In unadjusted analysis, AAUD was associated with significantly higher odds of post-operative infection (OR 2.50; 95% CI 1.93–3.23; p < 0.001). After adjusting for ISS, age, sex, race, and insurance, AAUD remained an independent predictor (OR 1.50, 95% CI 1.14–1.97, p = 0.003). Higher ISS, male sex, and Black or Asian race also independently increased infection risk. Conclusions:  In this TQIP cohort of hip fractures, AAUD was independently associated with POI. Male sex, higher ISS, and Black or Asian race also increased infection risk, highlighting the need for targeted risk mitigation in these populations.

Temporal Profiling of the Unfolded Protein Response Identifies PERK Activation as a Marker of Complicated Sepsis Outcomes

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Temporal Profiling of the Unfolded Protein Response Identifies PERK Activation as a Marker of Complicated Sepsis Outcomes

Authors:
Surmai Shukla, Timothy R. Billiar, Andrew C. Sayce

Body of Abstract:
Background:  

Sepsis is a life-threatening condition caused by a dysregulated host response to infection, leading to organ dysfunction. The cellular stress response during sepsis extends beyond inflammation to involve dysregulated proteostasis and Endoplasmic Reticulum (ER) stress. We aimed to characterize unfolded protein response (UPR)-related molecular signatures in sepsis to uncover potential mechanistic drivers of organ failure in sepsis and its relationship to the Endotypes in MARS consortium. 

Methods: 

Whole-blood human bulk RNA transcriptomic data (n=802) was analyzed.  UPR arm- specific (ATF6, IRE1 α, PERK) gene signatures were developed based on previously published Perturb-Seq gene classification. Briefly, z-score based gene activation, a composite representative of pathway activation, was compared across clinical recovery classes and four clinical endotypes of the MARS sepsis registry, MARS1= immunoparalysed high mortality group; MARS2 = hyperinflammatory innate activation endotype; MARS3 = increased adaptive immunity and  low risk endotype, MARS4 = interferon pathway driven hyperinflammatory group. Associations were evaluated using principal componentanalysis, group comparison tests, and linear regression.  

Results:  

UPR-related genes alone can differentiate clinical endotypes and reveal marked heterogeneity. Global UPR score differed between controls and patients with sepsis (p<0.05). MARS1 (highest mortality) showed decreased global UPR activity as compared with MARS2 (p<0.001) and MARS3 (p<0.01). PERK scores were elevated in non-survivors (p=<0.001) and PERK was significantly increased in patients who died from sepsis (p<0.001).  This effect was strongest in MARS1 (p<0.01) but also noted in MARS2 (p<0.05). MARS4 had higher activation of PERK but no significant difference was detected for mortality. Greater activation of ATF6 was seen in MARS2 and MARS3 as compared with MARS1 endotype. IRE1α scores were increased in sepsis (p<0.001) and endotype differences mirrored those findings for ATF6a.   Conclusion:   ER-stress biology mirrored MARS endotype heterogeneity, implying that regulation of proteostasis correlates with clinical outcomes such as immune status and mortality. Dysregulated UPR signaling differentiates clinical sepsis endotypes;sepsis triggers UPR with predominant PERK activation in the patients who die, with suppression of  ATF6/IRE1 pathway. We present the first quantitative approach to measure severity of ER stress in human transcriptomics.  Our results indicate that manipulation of UPR sub-pathways may offer a precision therapeutic window in sepsis patients directed by endotype and associated clinical features.

Postoperative Surgical-Site Infection Following Burn Injury and Its Impact on Long-Term Survival

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Postoperative Surgical-Site Infection Following Burn Injury and Its Impact on Long-Term Survival

Authors:
Lucineia Gainski Danielski

Body of Abstract:
BACKGROUND

Postoperative surgical-site infection is a common complication among burn patients and is associated with increased acute morbidity. However, its long-term clinical and neurocognitive consequences remain poorly characterized. This study evaluated short- and long-term outcomes in burn patients who developed postoperative infection, compared with those without infection, in a large real-world cohort.

METHODS

A retrospective cohort study was conducted using harmonized electronic health record data. Adult patients with burn injuries (ICD-10 T20–T25, T31) were identified and stratified by postoperative infection status (T81.4). Outcomes were assessed at 1-year and 20-year intervals after the index injury. Propensity score matching accounted for demographics, burn severity, and significant comorbidities. Primary outcomes included sepsis-related complications, acute kidney injury (AKI), respiratory failure, delirium, reinfection, and all-cause mortality. Kaplan–Meier survival analyses and hazard ratios (HR) with 95% confidence intervals were calculated.

RESULTS

Postoperative infection was associated with significantly worse outcomes across all time horizons. Within 1 year, infected patients had markedly higher mortality (HR 2.44; 95% CI 1.74–3.41; p=0.022) and increased risk of acute kidney injury (HR 2.07; 95% CI 1.30–3.30; p<0.001). Delirium was more frequent but not statistically significant (HR 1.34; 95% CI 0.85–2.12; p=0.93). Long-term follow-up demonstrated persistently elevated mortality (20-year HR 1.49; 95% CI 1.11–2.01; p=0.007) and higher risk of reinfection (HR 1.77; 95% CI 1.38–2.27; p=0.001) among patients who developed postoperative infection. CONCLUSIONS Postoperative infection following burn injury remains independently associated with increased organ dysfunction, reinfection, and both short- and long-term mortality. These findings underscore the critical need for aggressive infection prevention, early treatment strategies, and long-term surveillance in this vulnerable population.

Temporal Trends and Understanding the Impact of an Artificial Intelligence Abstraction Tool on the Discordance of NHSN and ACS NSQIP Surgical Site Infection Reporting

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Temporal Trends and Understanding the Impact of an Artificial Intelligence Abstraction Tool on the Discordance of NHSN and ACS NSQIP Surgical Site Infection Reporting

Authors:
Brayden Seal, Evan Abbey, Samantha Hendren, Anthony Yang, Sanjay Mohanty, Elizabeth Danielson, Ryan Merkow

Body of Abstract:
BACKGROUND

Accurate surveillance of surgical site infections (SSIs) is critical for patient safety, quality improvement, and institutional benchmarking. Although both the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) and the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) monitor SSIs, prior studies have consistently shown substantial discrepancies between the two, with NHSN identifying fewer cases. As data abstraction grows increasingly automated and integrated into the electronic health record (EHR), it remains unclear whether these advances will meaningfully enhance data accuracy or mitigate discrepancies. Our objectives were to (1) evaluate temporal trends in discordance between NHSN and ACS NSQIP and (2) assess the impact of an automated artificial intelligence (AI) abstraction tool on NHSN data accuracy.

METHODS

We analyzed SSIs (superficial, deep, and organ space) captured by NHSN and ACS NSQIP for adults undergoing colon surgery at a large urban academic medical center (2015-2024). Agreement in SSI identification for overlapping encounters was assessed using Cohen’s kappa. Temporal trends in the NHSN–NSQIP incidence gap and Cohen’s kappa were evaluated using weighted least squares regression with inverse variance as weights. In 2023, our institution implemented an EHR-based AI data abstraction tool.

RESULTS

Over the ten-year study period, we analyzed 7,720 patient encounters: 5,242 surveyed by NHSN, 2,478 surveyed by ACS NSQIP, and 2,082 surveyed by both programs. Cumulative SSI incidence was 6.5% (95% CI, 5.8 – 7.1) in NHSN encounters and 10.7% (95% CI, 9.5 – 11.9) in ACS NSQIP. Among overlapping encounters, agreement was moderate (kappa = 0.43). In 2015-2017, NHSN rates were substantially lower than ACS NSQIP, but this gap narrowed beginning in 2018 (Figure). Regression analysis showed the incidence gap decreased by 6% per year (p < 0.05). Yearly kappa values remained approximately 0.3 - 0.5 (p = 0.15). Cohen’s kappa did not significantly change after introduction of the AI abstraction tool (0.366 in 2022 and 0.567 in 2024, p = 0.22). CONCLUSIONS  The gap in SSI rates reported by NHSN and ACS NSQIP has narrowed over the past decade, yet concordance remains only moderate even after introduction of AI-facilitated data abstraction. This suggests that although more efficient and reproducible workflows have improved NHSN case capture, subtle inaccuracies persist. Both systems can track meaningful trends, but case-level data from each should guide targeted interventions.

Pre-admission Intravenous Drug Abuse is Associated with Reduced Index Morbidity but Higher Post-Discharge Hospital Utilization following Necrotizing Soft Tissue Infections

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Pre-admission Intravenous Drug Abuse is Associated with Reduced Index Morbidity but Higher Post-Discharge Hospital Utilization following Necrotizing Soft Tissue Infections

Authors:
Jasmine Kelley, Clark Ingram, Courtney Collins, Brooke Davis, Holly Baselice, Jinwei Hu, Jon Wisler, Anahita Jalilvand

Body of Abstract:
Introduction: While pre-admission intravenous drug use has been associated with certain types of necrotizing soft tissue infections (NSTIs), its impact on post-operative outcomes and healthcare utilization is unclear. The primary objective of this study was to characterize the impact of pre-admission IVDU on index hospitalization and 90-day outcomes following admission for NSTIs. 

Methods: We reviewed 625 NSTI patients at a single tertiary care institution (2013-2023). A chart review was conducted to obtain detailed baseline characteristics, operative, microbial, and antibiotic data, and complete 90-day outcomes. All data pertaining to 90-day ED visits/readmissions were documented if captured in our statewide electronic medical record. Comparisons were made between the IVDU cohort (n=65) and non-IVDU patients (n=569). A p<0.005 was considered statistically significant.  Results: Compared to the control group, IVDU patients were younger (42(33-49) vs 56 (46-64), p<0.005), had a lower median BMI (26.6 (23.3-30.3) vs 34.9 (28.7-43.6), p<0.005), were less likely to have a PCP (31% vs 60%, p<0.005), had lower Charlson Comorbidity Index (1 (0-3) vs 4 (2-6), p<0.005) and SOFA scores (1(0-3) vs 2(1-4), p = 0.004). Patients with IVDU history had higher prevalence of extremity NSTIs (74% vs 38%, p<0.005) with Group A Strep (23% vs 9%, p<0.005) but lower incidence of amputations (9% vs 5%, p=0.03) or gram negative culture growth (45% vs 67%, p<0.005). The IVDU cohort was associated with decreased ICU stay (37% vs 66%, p<0.005), mechanical ventilation (22% vs 41%, p<0.005), vasopressors use (28% vs 42%, p=0.003) and dependent discharge (43% vs 54%, p=0.003). Compared to the control group, IVDU patients had higher overall 90-day readmissions (52% vs 35%, p=0.01), increased incidence of 2+ readmissions (24% vs 12%, p=0.02), and NSTI-related readmissions (43% vs 19%, p<0.005). Additionally, they were readmitted sooner following discharge (13 days (4-25) vs 25 days (9-47), p=0.005), had less post discharge follow-up (31% vs 60%, p=0.007), and trended towards having shorter readmission stay (<24 hours) (33% vs 18%, p =0.1). IVDU was an independent predictor of having an NSTI-related readmission within 90-days (OR 2.1, 95th CI: 1.1-4.0), after controlling for age, NSTI location, transfer status, time to operation, admission SOFA, sex.  Discussion: Despite reduced index hospital morbidity, patients with IVDU history had higher overall 90-day NSTI-related readmissions and were readmitted sooner than non-IVDU patients. Given the timing and cause of these visits, these data support optimizing follow-up practices with earlier clinic visits and/or utilization of alternative modalities (ex. Telehealth) to mitigate potentially modifiable readmissions for this population.

Predictors of Intra-abdominal Infection after Temporary Abdominal Closure in Emergency General Surgery

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Predictors of Intra-abdominal Infection after Temporary Abdominal Closure in Emergency General Surgery

Authors:
Avery A. Thompson, Jillian K. Wothe, Manuel Castillo-Angeles, John Gaspich, Ali Salim, Reza Askari, Kristin A. Madenci

Body of Abstract:
Introduction: Damage control laparotomy (DCL) with temporary abdominal closure (TAC) is well described in trauma, however existing studies in emergency general surgery (EGS) are limited. We aimed to understand risk factors for the development of intra-abdominal infection after definitive abdominal closure among EGS patients undergoing DCL+TAC. 

Methods: We performed a ten year retrospective review of our institution’s EGS patients who underwent DCL+TAC. We collected patient characteristics including pre-, intra-, and post-operative factors. We performed multivariable logistic regression to identify potentially modifiable risk factors for the development of intra-abdominal infection (leak or abscess) after definitive closure. 

Results: A total of 2,171 patients underwent exploratory laparotomy during the study period (2015-2024). 411 (19%) were EGS patients who underwent DCL+TAC. Median age was 65 (53-73), 41% (N=169) were female, and 82% (N=340) were non-Hispanic White. 330 patients (80%) survived until closure and 94 patients (28%) developed an intra-abdominal infection after definitive closure. On multivariable analysis, age was inversely associated with risk of infection (adjusted OR 0.95 [95% CI 0.92-0.98], p=0.001) (Table 1). Patients who underwent ostomy creation were less likely to develop an infection (adjusted OR 0.33 [95% CI 0.14-0.74], p=0.009). Malnutrition requiring total parenteral nutrition (TPN) or gastrostomy tube placement with initiation of tube feeds was a risk factor for infection, with an adjusted OR of 5.49 (95% CI 2.28-14.60, p<0.001). Patients with bowel ischemia were less likely to develop infection after definitive closure than patients with perforated bowel or intra-abdominal sepsis, with an adjusted OR of 0.26 (95% CI 0.10-0.65, p=0.005). Laparotomy duration, post-operative volume resuscitation and blood transfusion, blood loss, intestinal discontinuity, ventilator days, and pressor use were not independently associated with post-closure infection.  Conclusion:  EGS patients who undergo DCL+TAC and survive to definitive abdominal closure are at risk for many short- and long-term complications. Diversion via ostomy creation is protective against intra-abdominal infection after definitive closure, likely due to the decreased risk of anastomotic leak. Initiation of supplemental nutrition via TPN or tube feeds via G-tube is likely a marker of illness severity, which overall places these patients at a higher risk of infection. Bowel ischemia, while otherwise morbid, was protective against the development of intra-abdominal infection compared to patients with a bowel perforation or intra-abdominal sepsis. Understanding these potentially modifiable risk factors can help guide intra- and post-operative decision making for this population.

Preoperative Antibiotics May Not Be a Major Factor in Surgical Site Infection Rates in Patients Undergoing Urgent Hemorrhage-Control Laparotomy

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Preoperative Antibiotics May Not Be a Major Factor in Surgical Site Infection Rates in Patients Undergoing Urgent Hemorrhage-Control Laparotomy

Authors:
Julia E Burrows, Chloe Lai, David M Rosenberg, Rogelio E Molina, Alexander C Schwed, Jessica A Keeley, Eric O Yeates

Body of Abstract:
Background: Preoperative antibiotics are recommended for all trauma patients undergoing laparotomy to prevent surgical site infections (SSI). However, in patients who need urgent hemorrhage-control laparotomy, achieving pre-incision antibiotic administration can be challenging due to time constraints, lack of intravenous access, and prioritization of blood transfusions. Given that these patients often have preexisting intra-abdominal contamination and competing interests, we aimed to evaluate whether preoperative antibiotics significantly affect SSI rates in patients undergoing hemorrhage-control laparotomy for trauma.  

Methods: The American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from 2020-2023 was queried for patients who underwent hemorrhage-control laparotomy within one hour of presentation. Patients who died within 48 hours of presentation or those who underwent other operations outside of the abdomen were excluded. Included patients were divided into two groups: those who received prophylactic antibiotics prior to laparotomy and those who did not. These groups were then propensity score matched (3:1) using age, sex, comorbidities, mechanism of injury, injury severity, hypotension, number of blood transfusions, and intraabdominal organs injured.  Logistic regression was used to compare infectious outcomes between the two groups.  

Results:  13,823 patients were identified who underwent hemorrhage control laparotomy within one hour of presentation, 898 of these patients received preoperative antibiotics. Direct comparison of these two groups demonstrated higher rates of SSI in those who received preoperative antibiotics: 8.6% v. 6.1% (p=0.003). 3:1 propensity matching resulted in two groups: 897 who received preoperative antibiotics and 2691 who did not. Standardized mean differences (SMD) for all covariates were < 0.1 after matching.  Logistic regression revealed no difference in rates of overall SSIs between the groups [8.6% v 7.4%, OR 1.2 (0.90-1.6), p=0.23]. There was also no difference in rates of superficial incisional SSIs [2.1% v 1.8%, OR 1.2 (0.68-2.0), p=0.57], deep incisional SSIs [2.5% v 2.3%, OR 1.1 (0.65-1.7), p=0.80], or organ space SSIs [4.7% v 3.9%, OR 1.3 (0.92-1.8), p=0.13].   Conclusion: In urgent hemorrhage-control trauma laparotomy cases, which often already have contamination present, pre-incision antibiotic administration may be a less important factor for preventing SSI than previously described. These findings suggest that clinicians may reasonably prioritize resuscitation and hemorrhage control over antibiotic administration when necessary.

Primary prevention of surgical site infection: an antibiotic timing pilot

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Primary prevention of surgical site infection: an antibiotic timing pilot

Authors:
Alicia C. Speak, Annmarie Vilkins, Arielle Gupta, Anita B Shallal, Trevor Szymanski, Abigail Ruby, Eman Chami

Body of Abstract:
Background:  

Surgical site infections (SSI) are the most common complications of gynecologic procedures. Risk factors for SSI include surgical site, type and duration of surgery, and patient risk factors. Surgical infection prophylaxis (SIP) is a core strategy employed to reduce SSI, and the timing of antibiotics is of critical importance. Clinical guidelines recommend the use of cefazolin within 60 minutes of surgical incision. Following an observed increase in SSI standardized infection ratio (SIR) for gynecologic surgeries at our institution, a multi-disciplinary collaborative effort for antibiotic timing was introduced.  

Methods: 

This was an IRB exempt, single pre-test, post-test quasi-experiment at a single institution. All gynecologic cases between 1/1/2025-11/6/2025 requiring antibiotic prophylaxis per consensus guidelines were included. The intervention was introduced on 8/20/2025, where antibiotics were initiated on arrival to the operating room or at pre-induction time out if not already done. This was achieved through education roll-out to key stakeholders, including gynecology, anesthesia, and nursing teams.  The primary endpoint was the timing of cefazolin SIP post-intervention, and secondary endpoint was the number of SSI cases post-intervention. A chi-square test of independence was conducted to examine the effect of the intervention on time to antibiotic administration, and Cramer’s V was calculated to measure the strength of association. “Ideal” antibiotic timing was defined as receiving antibiotics within 31-60 minutes pre-incision. 

Results:  

232 total cases were identified, including 183 pre-intervention and 44 post-intervention.   There was a statistically significant difference in the number of patients who received ideal antibiotic timing for cefazolin in the post-intervention group (24; 54.4% compared to 43; 23.5% pre-intervention; p<0.005) [Figure 1]. In the pre-intervention group, 9 (4.92%) surgical site infections were identified, versus 0 (0.00%) in the post infection group.   Conclusions:   Improving the timing of SIP had a significant impact on our rates of SSI in gynecological operations, showing the importance of a multi-disciplinary approach on infection prevention in surgical patients. Following an educational roll-out with key stakeholders, antibiotics were significantly more likely to be given within an ideal timeframe. Our study is limited by the small number of post-intervention SSI, making interpretation difficult. There were also additional concomitant interventions (including re-training on appropriate scrub and abdominal preparation technique), that may confound these results and likely also contributed to decreased SSI rates.