Prolonged perioperative surgical prophylaxis within European hospitals: an exercise in uncertainty avoidance?

OBJECTIVES: Socio-cultural factors have been hypothesized to be important drivers for inappropriate antibiotic prescribing in ambulatory care. This study sought to assess any potential role in perioperative surgical prophylaxis (PAP) administered for >24 h (PAP > 24). Within hospitals, PAP continues to be administered for longer than 24 h, despite unequivocal evidence of ineffectiveness beyond this period. A recently published European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) has reported that in 70% of participating countries, PAP > 24 was administered in more than half of the surgical operations surveyed.

METHODS: Correlation and simple linear regression modelling was performed using the PAP > 24 proportions for the countries in the ECDC PPS report and the respective scores for the cultural construct of uncertainty avoidance (UA), as detailed by Hofstede.

RESULTS: Pearson correlation analysis produced a moderately strong coefficient (r) of 0.50 (95% CI 0.16-0.74; P = 0.007). Simple regression yielded a model of PAP > 24 = 29.87 + 0.40UA (R(2) = 0.25; P = 0.007).

CONCLUSIONS: Cultural factors, namely UA, appear to be an important driver for PAP > 24. Any strategy aimed at improving prolonged PAP should be informed by clear knowledge of local socio-cultural barriers, so as to achieve the most successful intervention possible.