Effectiveness of Operating Room Pharmacists’ Prescribing Intervention for Appropriate Use of Antimicrobial Prophylaxis in Otorhinolaryngology-Head and Neck Surgery: A Single-Center, Observational Study

Abstract

We investigated the impact of operating room pharmacists on the appropriate use of antimicrobial prophylaxis (AMP) in otorhinolaryngology-head and neck surgery. Patients without intervention by operating room pharmacists (April 1, 2017, to March 31, 2019) and those who underwent intervention by operating room pharmacists (October 1, 2019, to March 31, 2021) were compared. Additionally, an interrupted time-series (ITS) analysis was conducted as a sensitivity analysis to assess temporal trends. Overall, 1697 patients (999 in the non-intervention group and 698 in the intervention group) were included, and 213 matched pairs were analyzed after 1 : 1 propensity score matching. The compliance rate of AMP administered within 1 h prior to incision was significantly higher in the intervention group than in the non-intervention group (98.1 vs. 93.4%; p = 0.027). In the subgroup analysis, the compliance rate of the guideline-recommended initial dose in patients weighing ≥80 kg was significantly higher in the intervention group than in the non-intervention group (93.1 vs. 70.7%; p < 0.001). The compliance rate of additional doses administered at the guideline-recommended intervals in patients with an estimated glomerular filtration rate individualized body surface area (eGFR_ind) <50 mL/min was significantly higher in the intervention group than in the non-intervention group (89.8 vs. 80.4%; p = 0.041). ITS analysis showed that the improvement trend in AMP compliance stabilized after the intervention, indicating sustained intraoperative management. No significant differences were observed in the postoperative or total hospital stay between the two groups. In conclusion, interventions by operating room pharmacists significantly improved the appropriate use of intraoperative AMP.