Percentage of adult patients undergoing open cardiac surgery with antibiotic administration initiated within the appropriate time frame before surgical incision.

Surgical site infections are associated with significant morbidity and mortality.^1-4 Administration of preoperative antibiotic prophylaxis is one mechanism to prevent surgical site infections.^1-4

120 minutes prior to Surgery Start Time through Surgery Start Time

Adult patients undergoing open cardiac surgical procedures (determined by Procedure Type: Cardiac: value code: 1)

• Age <18 years
• ASA 6 including Organ Procurement (CPT: 01990)
• Lung transplants
• Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases as defined by the Procedure Type: Cardiac phenotype (value codes: 0, 2, 3, and 4)
• Patients already on scheduled antibiotics or had a documented infection prior to surgery, as specified by “Patient on Scheduled Antibiotics/Documented Infection” (value: 2) of the ABX Notes Phenotype

 Documentation of antibiotics administered before surgery start time. See ‘Other Measure Build Details’ for antibiotic timing expectations based upon antibiotic selection.

Acceptable Antibiotics and Associated Timing:

• Only doses administered via IV route (MPOG Concept ID: 2001) will be considered.
• If one of the appropriate antibiotics listed in the table above was given as a bolus in the appropriate time frame, the case will pass and any additional antibiotic infusions will not be considered.
• If only one antibiotic is administered for the case and is documented with infusion start and end times, the following logic will be applied:
  • If the infusion start time is within 60 minutes before incision (120 minutes for vancomycin), the case will pass.
  • If the infusion is still running at the time of incision, the case will pass.
  • If the infusion started after or at the same time as incision, the case will be flagged as ‘antibiotic administered late’. 

• If an antibiotic is administered but not included on the list of ‘acceptable’ antibiotics for cardiac surgery (above), the case will be flagged for ‘non-standard antibiotic selection.’
• For cases without a documented surgical incision time or procedure start time, the case will be flagged for review.
• Measure will only look for the prophylactic variance note (as determined by the ABX Notes Phenotype) if an antibiotic is not documented within the measure time frame. 
• Cases will be flagged for review if there is documentation indicating prophylactic antibiotics were given (Concept ID: 50181, 50182, 50622) but administration dose, route, and time are not documented in the electronic medication administration record.
• Cases will be flagged for review if there is documentation that an antibiotic was not ordered or there is documentation that the antibiotic is ‘not indicated.’
• Cases will be assigned one of the following results:
  • Passed - Antibiotic administered on time
  • Flagged - Non-standard antibiotic selection
  • Flagged - Prophylactic antibiotic administered (Not documented in MAR)
  • Flagged - Antibiotic not ordered/indicated per surgeon
  • Flagged - Incision/procedure start time documented: No
  • Flagged - Antibiotic administered too late
  • Flagged - Antibiotic administered too early
  • Flagged - Not administered for medical reasons
  • Excluded - Scheduled antibiotics/documented infection

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Not applicable

All anesthesia providers signed in at the time of Surgery Start Time.

1. Surat G, Bernsen D, Schimmer C: Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections. J Cardiothorac Surg 2021; 16:309
2. 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
3. Bardia A, Michel G, Farela A, Fisher C, Mori M, Huttler J, Lang AL, Geirsson A, Schonberger RB: Association of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections. J Thorac Cardiovasc Surg 2023 doi:10.1016/j.jtcvs.2023.03.031
4. Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F, Jacobs M, Fernando H, Bridges C; Workforce on Evidence-Based Medicine, Society of Thoracic Surgeons. The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. Ann Thorac Surg. 2007 Apr;83(4):1569-76. doi: 10.1016/j.athoracsur.2006.09.046. PMID: 17383396.