Antimicrobial Prophylaxis Redosing Reduces Surgical Site Infection Risk in Prolonged Duration Surgery Irrespective of Its Timing

  • Daniela Bertschi
  • Walter P. Weber
  • Jasmin Zeindler
  • Daniel Stekhoven
  • Robert Mechera
  • Lilian Salm
  • Marco Kralijevic
  • Savas D. Soysal
  • Marco von Strauss
  • Edin Mujagic
  • Walter R. MartiEmail author
Original Scientific Report



Long-duration surgery requires repeated administration of antimicrobial prophylaxis (amp). Amp “redosing” reduces incidence of surgical site infections (SSI) but is frequently omitted. Clinical relevance of redosing timing needs to be investigated. Here, we evaluated the effects of compliance with amp redosing and its timing on SSI incidence in prolonged duration surgery.


Data from >9000 patients undergoing visceral, trauma, or vascular surgery with elective or emergency treatment in two tertiary referral Swiss hospitals were analyzed. All patients had to receive amp preoperatively and redosing, if indicated. Antibiotics used were cefuroxime (1.5 or 3 g, if weight >80 kg), or cefuroxime and metronidazole (1.5 and 0.5 g, or 3 and 1 g doses, if weight >80 kg). Alternatively, in cases of known or suspected allergies, vancomycin (1 g), gentamicin (4 mg/Kg), and metronidazole or clindamycin (300 mg) with or without ciprofloxacin (400 mg) were used. Association of defined parameters, including wound class, ASA scores, and duration of operation, with SSI incidence was explored.


In the whole cohort, SSI incidence significantly correlated with duration of surgery (ρ = 0.73, p = 0.031). In 593 patients undergoing >240 min long interventions, duration of surgery was the only parameter significantly (p < 0.001) associated with increased SSI risk, whereas wound class, ASA scores, treatment areas, and emergency versus elective hospital entry were not. Redosing significantly reduced SSI incidence as shown by multivariate analysis (OR 0.60, 95% CI 0.37–0.96, p = 0.034), but exact timing had no significant impact.


Long-duration surgery associates with higher SSI incidence. Irrespective of its exact timing, amp redosing significantly decreases SSI risk.



Support by the Swiss National Science Foundation, the Hospital of Aarau, the University of Basel, the Gottfried und Julia Bangerter-Rhyner Foundation, the Hippocrate Foundation, and the Nora van Meeuwen-Häfliger Foundation is gratefully acknowledged.


This work was partially supported by the Swiss National Science Foundation, the Hospital of Aarau, the University of Basel, the Gottfried und Julia Bangerter-Rhyner Foundation, the Hippocrate Foundation, and the Nora van Meeuwen-Häfliger Foundation.

Compliance with ethical standards

Conflict of interest

No conflict of interest to be disclosed.

Supplementary material

268_2019_5075_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 kb)


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Daniela Bertschi
    • 1
  • Walter P. Weber
    • 2
  • Jasmin Zeindler
    • 2
  • Daniel Stekhoven
    • 3
  • Robert Mechera
    • 2
  • Lilian Salm
    • 4
  • Marco Kralijevic
    • 2
  • Savas D. Soysal
    • 2
  • Marco von Strauss
    • 4
  • Edin Mujagic
    • 2
  • Walter R. Marti
    • 4
    Email author
  1. 1.Department of Visceral SurgeryKantonsspital ChurChurSwitzerland
  2. 2.Department of General SurgeryUniversity Hospital BaselBaselSwitzerland
  3. 3.NEXUS Personalized Health TechnologiesETH ZurichZurichSwitzerland
  4. 4.Department of Visceral SurgeryKantonsspital AarauAarauSwitzerland

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