Percentage of adult patients undergoing open cardiac surgery with appropriate antibiotic selection, timing, and re-dosing administered for surgical site infection prophylaxis.

Surgical site infections (SSIs) are associated with significant morbidity and mortality.^1-4 Adequate serum and tissue concentrations of antimicrobial agents at the time of incision can prevent surgical site infections.^1-4 The Society of Thoracic Surgeons (STS) and the American Society of Health-System Pharmacists (ASHP) have published antimicrobial prophylaxis guidelines outline the recommendations for timing, redosing, and selection of prophylactic agents for cardiac surgery.  The ABX-05-C composite measure assesses overall adherence to the three cardiac surgery-specific antibiotic prophylaxis measures: ABX-02, ABX-03, ABX-04. If a case is flagged for any of the three antibiotic measures, ABX-05-C will also result as flagged. The goal of this measure is to allow departmental leaders the opportunity to assess overall compliance with an antibiotic prophylaxis bundle for patients undergoing cardiac surgery. 

120 minutes prior to Anesthesia Start through Anesthesia End

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)
• Patients already on scheduled antibiotics or had a documented infection prior to surgery (determined by ABX Notes value code: 2)
• Procedures:
  • Lung transplants, as defined by the Procedure Type: Lung Transplant phenotype
  • Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases (determined by Procedure Type: Cardiac value codes: 0, 2, 3, 4)

Case must pass all three antibiotic prophylaxis for open cardiac procedure measures:

• ABX-02-C
• ABX-03-C
• ABX-04-C

• 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 the case was flagged for any of the antibiotic prophylaxis for open cardiac procedure measures: ABX-02-C, ABX-03-C, ABX-04-C. 
• Cases will be assigned one of the following results:
  • Passed - Antibiotic Prophylaxis Standards Met
  • Flagged - Timing, Re-dosing, & Selection Not Met (ABX-02-C, ABX-03-C, & ABX-04-C flagged)
  • Flagged - Timing & Selection Not Met (ABX-02-C & ABX-04-C flagged)
  • Flagged - Re-dosing & Selection Not Met (ABX-03-C & ABX-04-C flagged)
  • Flagged - Timing and Re-dosing Not Met (ABX-02-C & ABX-03-C flagged)
  • Flagged - Antibiotic not administered on time (ABX-02-C flagged)
  • Flagged - Antibiotics not appropriately re-dosed (ABX-03-C flagged)
  • Flagged - Non-standard antibiotic selection (ABX-04-C flagged)
  • Excluded - Scheduled antibiotics/documented infection

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

Not applicable

Departmental only measure - not available for provider feedback emails.

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. https://www.sts.org/sites/default/files/documents/Clinical%20Guidelines/AntibioticProphylaxisCardiacSurgeryPart_IIAntibiotic_Choice.pdf