The Cost Effectiveness of Antimicrobial Prophylaxis in Clean Vascular Surgery

In the present investigation, the excess hospital costs of the preventable wound infections (i.e., those due to cefazolin-sensitive organisms) occurring among placebo recipients were compared with the cost of administering five 1-g doses of perioperative cefazolin ($2,500 per 100 operations). The observed infection rate exceeded the "breakeven" infection rate for each of the classes of infection and justified the use of perioperative cefazolin in each instance. It is quite possible, however, that other types of clean surgery in other medical centers will have a lower infection rate, a lower excess cost of infection, and/or higher cost of prophylaxis so that prophylactic antimicrobial therapy cannot be justified on a cost basis. However, when implantable materials are at risk of infection, the cost of infection is so excessive that prophylactic antimicrobial therapy can almost always be justified even with less than 1% risk of class III injection.