Percentage of adult patients undergoing an open cardiac procedure with an antibiotic redose initiated within four hours after initial antibiotic administration (cephalosporins only).

Surgical site infections are associated with significant morbidity and mortality.^1-4 Administration of on-time antibiotic prophylaxis redosing is one mechanism to prevent surgical site infections.^1-4 Administering cefazolin prophylactically as a bolus dose before surgery, followed by continuous infusion during the procedure, eliminates the requirement for redosing and may also reduce the risk of surgical site infections (SSIs) in cardiac surgery.^5-6

120 minutes before Anesthesia Start through Surgery End. If Surgery End is not available, Anesthesia End.

Adult patients undergoing open cardiac surgical procedures (determined by Procedure Type: Cardiac: value code 1) and receiving antibiotic prophylaxis with a cephalosporin.

• Age < 18 years
• ASA 6 including Organ Procurement (CPT: 01990)
• Cases where Surgery End time occurs before redose is due (less than 4 hours and 15 minutes after cephalosporin dose)
• Cases without administration of a cephalosporin for antibiotic prophylaxis
• Lung transplants
• Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases (determined by the Procedure Type: Cardiac value codes: 0, 2, 3, and 4)
• Patients already on scheduled antibiotics or had a documented infection prior to surgery as determined by “Patient on Scheduled Antibiotics/Documented Infection” of ABX Notes

Documentation of cephalosporin re-dose within 165-255 minutes after each cephalosporin administration.^5-6

For longer cases, a second re-dose within 165-255 minutes after initial re-dose is required unless the last cephalosporin dose is ≤255 minutes before Surgery End. If Surgery End is not available, Anesthesia End.

Acceptable Antibiotics and Associated Timing:

• Ceftriaxone and cefotetan are excluded due to extended half-lives relative to other commonly used cephalosporins and therefore, re-dosing is not recommended for a typical cardiac case.
• Cefoxitin is also excluded as it is not typically used for cardiac cases and would require more frequent re-dosing. 
• Only doses administered via IV route (MPOG Concept ID: 2001) will be considered.
• Any case where an antibiotic listed in the table above was not re-dosed within 165-255 minutes will be flagged unless there is ≤ 255 minutes between a cephalosporin dose and Surgery End (re-dose is not required although case will pass if re-dosed within that time frame. Otherwise case will be excluded.) If Surgery End is not available, Anesthesia End will be used. If only one dose is documented on the case and re-dose is not required, the case will be excluded.
• Maximum number of doses per case is three: 1 initial and up to two re-dose administrations.  
• If cephalosporin administration was documented as an infusion, infusion start time will be used to determine timing for re-dose. If the infusion is still running at time of re-dose, case will pass. 
• Measure will only look for the prophylactic variance note (as determined by the ABX Notes Phenotype) if an antibiotic re-dose is not documented within the appropriate time frame. If note returns ‘scheduled antibiotics/documented infection’ - case will be excluded. 
• Cases will be assigned one of the following results:
  • Passed - Re-dose(s) administered on time
  • Flagged - Antibiotic re-dose too late
  • Flagged - Antibiotic re-dose too early
  • Flagged - Antibiotic re-dose required but not given
  • Excluded - Scheduled antibiotics/documented infection
  • Excluded - No initial cephalosporin dose
  • Excluded - Re-dose not required
  • Excluded - ASA 6
  • Excluded - Non-Cardiac
  • Excluded - Age<18

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

Not applicable

Provider(s) signed in at the time of each re-dose (If not given: 255 minutes after initial cephalosporin dose, and/or if not given: 255 minutes after the first re-dose).

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.
5. Shoulders, B.R.; Crow, J.R.; Davis, S.L.; Whitman, G.J.; Gavin, M.; Lester, L.; Barodka, V.; Dzintars, K. Impact of Intraoperative Continuous-Infusion Versus Intermittent Dosing of Cefazolin Therapy on the Incidence of Surgical Site Infections After Coronary Artery Bypass Grafting. Pharmacotherapy 2016, 36, 166–173. [CrossRef] [PubMed]
6. Trent Magruder, J.; Grimm, J.C.; Dungan, S.P.; Shah, A.S.; Crow, J.R.; Shoulders, B.R.; Lester, L.; Barodka, V. Continuous Intraoperative Cefazolin Infusion May Reduce Surgical Site Infections During Cardiac Surgical Procedures: A Propensity - Matched Analysis. J. Cardiothorac. Vasc. Anesth. 2015, 29, 1582–1587.