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Invited Commentary
July 2013

Timing May Not Be Everything

Author Affiliations
  • 1Department of Surgery, University of Utah, Salt Lake City
JAMA Surg. 2013;148(7):657. doi:10.1001/jamasurg.2013.157

Ideally, any metric (especially a publicly reported one) should be reliable and valid. If it is a process measure, there should be a long track record of reports confirming that adherence to the measure is associated with significantly better results than nonadherence to the measure. Using large, validated, reliable data sets and sophisticated statistical analyses, Hawn et al1 have furthered their work showing little relationship between adherence to the publicly reported “quality” measure of the right antibiotic within 60 minutes of incision and improved outcomes. In this analysis, multiple statistical methods were used to tease out any potential associations. While there was a small association between antibiotic timing and surgical site infection in unadjusted analyses, the difference disappeared when the models were adjusted for patient, procedure, and antibiotic variables. This article is not a call to abandon prophylactic antibiotics when indicated, as most studies have shown a significant reduction in postoperative surgical site infections with their use (when compared with no antibiotics). However, it does once again strongly suggest that the current publicly reported measures are not associated with improved outcomes. As surgeons, we should work with federal and local agencies to define metrics that are more robustly associated with better outcomes for our patients.

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