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Invited Critique
Dec 2011

History and Comparative Effectiveness Research: Comment on “Antibiotic Prophylaxis Before Surgery vs After Cord Clamping in Elective Cesarean Delivery”

Author Affiliations

Author Affiliation: American Board of Surgery, Philadelphia, Pennsylvania.

Arch Surg. 2011;146(12):1409-1410. doi:10.1001/archsurg.2011.1024

Those who cannot remember the past are condemned to repeat it.—George Santayana

Comparative effectiveness research is a potentially useful tool to identify value in health care. The current report by Witt et al1 is an excellent example of this concept. This prospective, randomized trial of perioperative antimicrobial prophylaxis for women undergoing cesarean section followed recommended clinical trial guidelines, was adequately powered to demonstrate statistical significance (more than 1100 women were enrolled), and had an amazing 97% follow-up at 30 days, likely accounting for all measured outcomes. No study is flawless; here, there is the inherent bias of unstated practice patterns in a trial limited to a single institution. We also must assume that all other preventive measures necessary to minimize the number of surgical site infections were properly performed.