A retrospective audit of factors contributing to delays in preoperative antibiotic administration: Arrival-to-incision time in Kuwait

Background: Preoperative antibiotic administration within 60 minutes before surgical incision is a critical component of surgical site infection (SSI) prevention. Despite these guidelines, adherence to this protocol varies. Objective: This audit aimed to identify the factors contributing to the failure to administer preoperative antibiotics within the recommended timeframe. Methods: This retrospective audit examined patients booked for procedures at Kuwait Hospital from July 2022 to October 2022, with a reaudit in November 2022, focusing on Orthopaedic, Neurosurgery, and Plastic Surgery Departments. From the operation theatre and recovery room records, 1035 patients were identified, and 20 were randomly selected for the reaudit. Correlations among factors influencing preoperative antibiotic administration were analysed through a heatmap. Detailed data on operating room timings and antibiotic administration were collected and compiled into Excel sheets. Results: The study analysed 1035 major operations and found that 293 patients (28.31%) had delays of over 30 minutes from arrival to incision, the Orthopaedic, Neurosurgery, and Plastic surgery patients being the worst hit, with mean times to incision of 41 ± 18 minutes, 38 ± 13 minutes, and 35 ± 12 minutes respectively. General Surgery (17%) was the most common specialty, followed by Urology (15%) and others. A later prospective review of 20 cases found preoperative antibiotics to have been given within 30 minutes of incision in 5 of 8 Orthopaedic cases, 6 of 7 Neurosurgery cases, and 4 of 5 Plastic surgery cases. Correlation analysis between department and time to preoperative antibiotics was strongly associated (r = 0.61) with variability of departmental practice. Conclusion: Severe delays in Orthopaedic, Neurosurgery, and Plastic Surgery units impact surgical efficiency and antibiotic administration with implications for patient safety and infection prevention. Standardized protocols and ongoing audits are suggested for better compliance with surgical schedules and antibiotic protocols, ultimately leading to improved patient care and surgical outcomes. Improved communication, streamlined workflows, and adherence to standardized protocols are essential to ensure timely administration of preoperative antibiotics and reduce surgical site infection risks.