This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.
Percentage of cesarean deliveries with documentation of antibiotic administration initiated within one hour before surgical incision
60 minutes prior to Surgical Incision through Surgical Incision
Documentation of at least one antibiotic administration within one hour of surgical incision. See ‘Other Measure Build Details’ for emergency cases and antibiotic timing exceptions.
Measure Start Time:
Measure End Time:
Acceptable Antibiotics and Associated Timing:
Antibiotic |
MPOG Concept |
Appropriate Start Time |
Azithromycin |
10048 |
Within 60 minutes before incision/procedure start through Anesthesia End |
Cefazolin |
10107 |
Within 60 minutes before incision |
Cefepime |
10108 |
Within 60 minutes before incision |
Cefotaxime |
10109 |
Within 60 minutes before incision |
Cefotetan |
10110 |
Within 60 minutes before incision |
Cefoxitin |
10111 |
Within 60 minutes before incision |
Ceftriaxone |
10114 |
Within 60 minutes before incision |
Cefuroxime |
10115 |
Within 60 minutes before incision |
Clindamycin |
10131 |
Within 60 minutes before incision |
Gentamicin |
10202 |
Within 60 minutes before incision |
Vancomycin |
10444 |
Within 120 minutes before incision |
*Any of these antibiotics administered within the timeframe will result in success for this measure focused on antibiotic timing, rather than selection.
All anesthesia providers signed in at the time of incision. If surgical incision time is not documented (50235) then providers signed in at the procedure start time (50006) will be attributed. If procedure start time (50006) is not documented, then providers signed in at anesthesia start (50002) will be attributed.
Postpartum infections, including endometritis and surgical site infections are common after cesarean deliveries.1 Smaill & Hofmeyr conducted a large meta-analysis reviewing 81 randomized trials including 11,937 women undergoing elective or nonelective cesarean delivery.6 The analysis concluded that antimicrobial prophylaxis was associated with reduction in fever, endometritis, urinary tract infection, SSI, and serious infection.6 Historically, antibiotic prophylaxis was administered after cord clamping during cesarean delivery. However, recent studies suggest that prophylaxis should be administered before surgical incision to decrease the risk of maternal complications with no change in neonatal outcomes.3,5 Further, the antibiotic should be infused before incision in order to achieve peak antimicrobial concentrations in the tissue at the time of incision.1-2 Both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics support the use of single dose prophylaxis administered within 60 minutes before cesarean delivery to prevent maternal infectious morbidity.4
Not applicable.
1 Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Surgical Infection Society (SIS), Society for Healthcare Epidemiology of America (SHEA): Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect 2013; 14:73–156
2 Committee on Practice Bulletins-Obstetrics: ACOG Practice Bulletin No. 199: Use of Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol 2018; 132:e103–19
3 Costantine MM, Rahman M, Ghulmiyah L, Byers BD, Longo M, Wen T, Hankins GDV, Saade GR: Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2008; 199:301.e1–6
4 Guidelines for Perinatal Care Seventh Edition at <https://www.buckeyehealthplan.com/content/dam/centene/Buckeye/medicaid/pdfs/ACOG-Guidelines-for-Perinatal-Care.pdf>
5 Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK: Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev 2014:CD009516
6 Smaill F, Hofmeyr GJ: Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2002:CD000933