BACKGROUND. Randomized, controlled trials have shown that prophylactic antibiotics are effective in preventing surgical-wound infections. However, it is uncertain how the timing of antibiotic administration affects the risk of surgical-wound infection in actual clinical practice. METHODS. We prospectively monitored the timing of antibiotic prophylaxis and studied the occurrence of surgical-wound infections in 2847 patients undergoing elective clean or "clean-contaminated" surgical procedures at a large community hospital. The administration of antibiotics 2 to 24 hours before the surgical incision was defined as early; that during the 2 hours before the incision, as preoperative; that during the 3 hours after the incision, as perioperative; and that more than 3 but less than 24 hours after the incision, as postoperative. RESULTS. Of the 1708 patients who received the prophylactic antibiotics preoperatively, 10 (0.6 percent) subsequently had surgical-wound infections. Of the 282 patients who received the antibiotics perioperatively, 4 (1.4 percent) had such infections (P = 0.12; relative risk as compared with the preoperatively treated group, 2.4; 95 percent confidence interval, 0.9 to 7.9). Of 488 patients who received the antibiotics postoperatively, 16 (3.3 percent) had wound infections (P less than 0.0001; relative risk, 5.8; 95 percent confidence interval, 2.6 to 12.3). Finally, of 369 patients who had antibiotics administered early, 14 (3.8 percent) had wound infections (P less than 0.0001; relative risk, 6.7; 95 percent confidence interval, 2.9 to 14.7). Stepwise logistic-regression analysis confirmed that the administration of antibiotics in the preoperative period was associated with the lowest risk of surgical-wound infection. CONCLUSIONS. We conclude that in surgical practice there is considerable variation in the timing of prophylactic administration of antibiotics and that administration in the two hours before surgery reduces the risk of wound infection.
Source Information
Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, UT 84143.
This article has been cited by other articles:
Miliani, K., L'Heriteau, F., Astagneau, P., on behalf of the INCISO Network Study Group,
(2009). Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network. J Antimicrob Chemother
64: 1307-1315
[Abstract][Full Text]
Meehan, J., Jamali, A. A., Nguyen, H.
(2009). Prophylactic Antibiotics in Hip and Knee Arthroplasty. JBJS
91: 2480-2490
[Abstract][Full Text]
Appleby, J.
(2009). Does improving quality of care save money?. BMJ
339: b3678-b3678
[Full Text]
Qadan, M., Akca, O., Mahid, S. S., Hornung, C. A., Polk, H. C. Jr
(2009). Perioperative Supplemental Oxygen Therapy and Surgical Site Infection: A Meta-analysis of Randomized Controlled Trials. Arch Surg
144: 359-366
[Abstract][Full Text]
Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A.-H. S., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C. M., Merry, A. F., Moorthy, K., Reznick, R. K., Taylor, B., Gawande, A. A., the Safe Surgery Saves Lives Study Group,
(2009). A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. NEJM
360: 491-499
[Abstract][Full Text]
Kritchevsky, S. B., Braun, B. I., Bush, A. J., Bozikis, M. R., Kusek, L., Burke, J. P., Wong, E. S., Jernigan, J., Davis, C. C., Simmons, B., for the TRAPE Study Group,
(2008). The Effect of a Quality Improvement Collaborative to Improve Antimicrobial Prophylaxis in Surgical Patients: A Randomized Trial. ANN INTERN MED
149: 472-480
[Abstract][Full Text]
Uckay, I., Pittet, D., Bernard, L., Lew, D., Perrier, A., Peter, R.
(2008). Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee. J Bone Joint Surg Br
90-B: 833-838
[Abstract][Full Text]
Prokuski, L.
(2008). Prophylactic Antibiotics in Orthopaedic Surgery. J Am Acad Orthop Surg
16: 283-293
[Abstract][Full Text]
Rosenberg, A. D., Wambold, D., Kraemer, L., Begley-Keyes, M., Zuckerman, S. L., Singh, N., Cohen, M. M., Bennett, M. V.
(2008). Ensuring Appropriate Timing of Antimicrobial Prophylaxis. JBJS
90: 226-232
[Abstract][Full Text]
Olsen, M. A., Nepple, J. J., Riew, K. D., Lenke, L. G., Bridwell, K. H., Mayfield, J., Fraser, V. J.
(2008). Risk Factors for Surgical Site Infection Following Orthopaedic Spinal Operations. JBJS
90: 62-69
[Abstract][Full Text]
Bond, C. A., Raehl, C. L.
(2007). Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. Am J Health Syst Pharm
64: 1935-1942
[Abstract][Full Text]
Fletcher, N., Sofianos, D., Berkes, M. B., Obremskey, W. T.
(2007). Prevention of Perioperative Infection. JBJS
89: 1605-1618
[Full Text]
Soubhi, H.
(2007). Toward an Ecosystemic Approach to Chronic Care Design and Practice in Primary Care. Ann Fam Med
5: 263-269
[Abstract][Full Text]
Engelman, R., Shahian, D., Shemin, R., Guy, T. S., Bratzler, D., Edwards, F., Jacobs, M., Fernando, H., Bridges, C.
(2007). The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part II: Antibiotic Choice. Ann. Thorac. Surg.
83: 1569-1576
[Full Text]
McCahill, L. E., Ahern, J. W., Gruppi, L. A., Limanek, J., Dion, G. A., Sussman, J. A., McCaffrey, C. B., Leary, D. B., Lesage, M. B., Single, R. M.
(2007). Enhancing Compliance With Medicare Guidelines for Surgical Infection Prevention: Experience With a Cross-disciplinary Quality Improvement Team. Arch Surg
142: 355-361
[Abstract][Full Text]
Bhattacharyya, T., Hooper, D. C.
(2007). Antibiotic Dosing Before Primary Hip and Knee Replacement as a Pay-for-Performance Measure. JBJS
89: 287-291
[Abstract][Full Text]
Parker, B. M., Henderson, J. M., Vitagliano, S., Nair, B. G., Petre, J., Maurer, W. G., Roizen, M. F., Weber, M., DeWitt, L., Beedlow, J., Fahey, B., Calvert, A., Ribar, K., Gordon, S.
(2007). Six Sigma Methodology Can Be Used to Improve Adherence for Antibiotic Prophylaxis In Patients Undergoing Noncardiac Surgery. Anesth. Analg.
104: 140-146
[Abstract][Full Text]
Kanter, G., Connelly, N. R., Fitzgerald, J.
(2006). A System and Process Redesign to Improve Perioperative Antibiotic Administration. Anesth. Analg.
103: 1517-1521
[Abstract][Full Text]
Fonseca, S. N. S., Melon Kunzle, S. R., Junqueira, M. J., Nascimento, R. T., de Andrade, J. I., Levin, A. S.
(2006). Implementing 1-Dose Antibiotic Prophylaxis for Prevention of Surgical Site Infection. Arch Surg
141: 1109-1113
[Abstract][Full Text]
Walz, J. M., Paterson, C. A., Seligowski, J. M., Heard, S. O.
(2006). Surgical Site Infection Following Bowel Surgery: A Retrospective Analysis of 1446 Patients. Arch Surg
141: 1014-1018
[Abstract][Full Text]
Garey, K. W., Dao, T., Chen, H., Amrutkar, P., Kumar, N., Reiter, M., Gentry, L. O.
(2006). Timing of vancomycin prophylaxis for cardiac surgery patients and the risk of surgical site infections. J Antimicrob Chemother
58: 645-650
[Abstract][Full Text]
Caffarelli, A. D., Holden, J. P., Baron, E. J., Lemmens, H. J.M., D'Souza, H., Yau, V., Olcott, C. IV, Reitz, B. A., Miller, D. C., van der Starre, P. J.A.
(2006). Plasma cefazolin levels during cardiovascular surgery: Effects of cardiopulmonary bypass and profound hypothermic circulatory arrest. J. Thorac. Cardiovasc. Surg.
131: 1338-1343
[Abstract][Full Text]
Warters, R. D., Szmuk, P., Pivalizza, E. G., Gebhard, R. E., Katz, J., Ezri, T.
(2006). The role of anesthesiologists in the selection and administration of perioperative antibiotics: a survey of the american association of clinical directors.. Anesth. Analg.
102: 1177-1182
[Abstract][Full Text]
Tan, J A, Naik, V N, Lingard, L
(2006). Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections. Qual Saf Health Care
15: 32-38
[Abstract][Full Text]
van Kasteren, M. E. E., Mannien, J., Kullberg, B.-J., de Boer, A. S., Nagelkerke, N. J., Ridderhof, M., Wille, J. C., Gyssens, I. C.
(2005). Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. J Antimicrob Chemother
56: 1094-1102
[Abstract][Full Text]
Bratzler, D. W., Houck, P. M., Richards, C., Steele, L., Dellinger, E. P., Fry, D. E., Wright, C., Ma, A., Carr, K., Red, L.
(2005). Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results From the National Surgical Infection Prevention Project. Arch Surg
140: 174-182
[Abstract][Full Text]
Ritchie, S, Scanlon, N, Lewis, M, Black, P N
(2004). Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery. Qual Saf Health Care
13: 384-387
[Abstract][Full Text]
Rello, J., Diaz, E.
(2004). Ventilator-Associated Pneumonia, Percutaneous Tracheostomy, and Antimicrobial Prophylaxis. Chest
126: 1382-1383
[Full Text]
Martich, G. D., Waldmann, C. S., Imhoff, M.
(2004). Clinical Informatics in Critical Care. J Intensive Care Med
19: 154-163
[Abstract]
Vandecasteele, S. J., Peetermans, W. E., Carbonez, A., Van Eldere, J.
(2004). Metabolic Activity of Staphylococcus epidermidis Is High during Initial and Low during Late Experimental Foreign-Body Infection. J. Bacteriol.
186: 2236-2239
[Abstract][Full Text]
Sauer, S.
(2003). Topical Antibiotics Before Cataract Surgery. JAMA
290: 2937-2938
[Full Text]
(2003). Antibacterial prophylaxis in surgery: 1 - Gastrointestinal and biliary. DTB
41: 83-86
[Abstract][Full Text]
Burke, J. P.
(2003). Infection Control -- A Problem for Patient Safety. NEJM
348: 651-656
[Full Text]
Aasi, S. Z., Leffell, D. J.
(2003). Complications in Dermatologic Surgery: How Safe Is Safe?. Arch Dermatol
139: 213-214
[Full Text]
Zelenitsky, S. A., Ariano, R. E., Harding, G. K. M., Silverman, R. E.
(2002). Antibiotic Pharmacodynamics in Surgical Prophylaxis: an Association between Intraoperative Antibiotic Concentrations and Efficacy. Antimicrob. Agents Chemother.
46: 3026-3030
[Abstract][Full Text]
Olsen, M. A., Lock-Buckley, P., Hopkins, D., Polish, L. B., Sundt, T. M., Fraser, V. J.
(2002). The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J. Thorac. Cardiovasc. Surg.
124: 136-145
[Abstract][Full Text]
Velmahos, G. C., Toutouzas, K. G., Sarkisyan, G., Chan, L. S., Jindal, A., Karaiskakis, M., Katkhouda, N., Berne, T. V., Demetriades, D.
(2002). Severe Trauma Is Not an Excuse for Prolonged Antibiotic Prophylaxis. Arch Surg
137: 537-542
[Abstract][Full Text]
Morris, A H
(2002). Decision support and safety of clinical environments. Qual Saf Health Care
11: 69-75
[Abstract][Full Text]
Finkelstein, R., Rabino, G., Mashiah, T., Bar-El, Y., Adler, Z., Kertzman, V., Cohen, O., Milo, S.
(2002). Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections. J. Thorac. Cardiovasc. Surg.
123: 326-332
[Abstract][Full Text]
Eggimann, P., Pittet, D.
(2001). Infection Control in the ICU. Chest
120: 2059-2093
[Abstract][Full Text]
Borer, A., Gilad, J., Meydan, N., Riesenberg, K., Schlaeffer, F., Alkan, M., Schlaeffer, P.
(2001). Impact of active monitoring of infection control practices on deep sternal infection after open-heart surgery. Ann. Thorac. Surg.
72: 515-520
[Abstract][Full Text]
Keffer, J. H.
(2001). Guidelines and Algorithms: Perceptions of Why and When They Are Successful and How to Improve Them. Clin. Chem.
47: 1563-1572
[Abstract][Full Text]
Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., Sheridan, T.
(2001). Reducing the Frequency of Errors in Medicine Using Information Technology. J. Am. Med. Inform. Assoc.
8: 299-308
[Abstract][Full Text]
Fisher, C., Fiorilli, M. G.
(2001). Commentary: Applying Hospital Quality Indicators to Clinical Practice. American Journal of Medical Quality
16: 58-60
[Abstract]
Kollef, M. H., Fraser, V. J.
(2001). Antibiotic Resistance in the Intensive Care Unit. ANN INTERN MED
134: 298-314
[Abstract][Full Text]
Rebuck, J. A, Murry, K. R, Rhoney, D. H, Michael, D. B, Coplin, W. M
(2000). Infection related to intracranial pressure monitors in adults: analysis of risk factors and antibiotic prophylaxis. J. Neurol. Neurosurg. Psychiatry
69: 381-384
[Abstract][Full Text]
Harbarth, S., Samore, M. H., Lichtenberg, D., Carmeli, Y.
(2000). Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance. Circulation
101: 2916-2921
[Abstract][Full Text]
Alonso-Echanove, J., Richards, C., Horan, T. C., Lee, J. T., Sessler, D. I., Greif, R. T.
(2000). Supplemental Perioperative Oxygen to Reduce Surgical-Wound Infections. NEJM
342: 1613-1614
[Full Text]
Greif, R., Akca, O., Horn, E.-P., Kurz, A., Sessler, D. I., The Outcomes Research Group,
(2000). Supplemental Perioperative Oxygen to Reduce the Incidence of Surgical-Wound Infection. NEJM
342: 161-167
[Abstract][Full Text]
Trick, W. E., Scheckler, W. E., Tokars, J. I., Jones, K. C., Reppen, M. L., Smith, E. M., Jarvis, W. R.
(2000). MODIFIABLE RISK FACTORS ASSOCIATED WITH DEEP STERNAL SITE INFECTION AFTER CORONARY ARTERY BYPASS GRAFTING. J. Thorac. Cardiovasc. Surg.
119: 108-114
[Abstract][Full Text]
Van Wijngaerden, E., Peetermans, W. E., Vandersmissen, J., Van Lierde, S., Bobbaers, H., Van Eldere, J.
(1999). Foreign body infection: a new rat model for prophylaxis and treatment. J Antimicrob Chemother
44: 669-674
[Abstract][Full Text]
Behlen, F. M., Johnson, S. B.
(1999). Multicenter Patient Records Research: Security Policies and Tools. J. Am. Med. Inform. Assoc.
6: 435-443
[Abstract][Full Text]
Kuperman, G. J., Teich, J. M., Tanasijevic, M. J., Ma'Luf, N., Rittenberg, E., Jha, A., Fiskio, J., Winkelman, J., Bates, D. W.
(1999). Improving Response to Critical Laboratory Results with Automation: Results of a Randomized Controlled Trial. J. Am. Med. Inform. Assoc.
6: 512-522
[Abstract][Full Text]
Eagle, K. A., Guyton, R. A., Davidoff, R., Ewy, G. A., Fonger, J., Gardner, T. J., Gott, J. P., Herrmann, H. C., Marlow, R. A., Nugent, W. C., O'Connor, G. T., Orszulak, T. A., Rieselbach, R. E., Winters, W. L., Yusuf, S., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Garson, A. Jr., Gregoratos, G., Russell, R. O., Smith, S. C. Jr.
(1999). ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol
34: 1262-1347
[Full Text]
SPANGEHL, M. J., MASRI, B. A., O'CONNELL, J. X., DUNCAN, C. P.
(1999). Prospective Analysis of Preoperative and Intraoperative Investigations for the Diagnosis of Infection at the Sites of Two Hundred and Two Revision Total Hip Arthroplasties. JBJS
81: 672-83
[Abstract][Full Text]
Collier, P. E., Rudolph, M., Ruckert, D., Osella, T., Collier, N. A., Ferrero, M.
(1998). Are Preoperative Antibiotics Administered Preoperatively?. American Journal of Medical Quality
13: 94-97
[Abstract]
Griego, R. D., Zitelli, J. A.
(1998). Intra-Incisional Prophylactic Antibiotics for Dermatologic Surgery. Arch Dermatol
134: 688-692
[Abstract][Full Text]
Da Costa, A., Kirkorian, G., Cucherat, M., Delahaye, F., Chevalier, P., Cerisier, A., Isaaz, K., Touboul, P.
(1998). Antibiotic Prophylaxis for Permanent Pacemaker Implantation : A Meta-Analysis. Circulation
97: 1796-1801
[Abstract][Full Text]
Headrick, L. A., Richardson, A., Priebe;, G. P., Bergman, D.
(1998). Continuous Improvement Learning for Residents. Pediatrics
101: 768-774
[Abstract][Full Text]
Kernodle, D. S., Gates, H., Kaiser, A. B.
(1998). Prophylactic Anti-Infective Activity of Poly-[1-6]-beta -D-Glucopyranosyl-[1-3]-beta -D-Glucopyranose Glucan in a Guinea Pig Model of Staphylococcal Wound Infection. Antimicrob. Agents Chemother.
42: 545-549
[Abstract][Full Text]
Jacoberger, B., Ubeaud, G., Freys, G., Pottecher, T., Jung, L., Koffel, J. C.
(1998). Concentrations of Pefloxacin in Plasma and Tissue after Administration as Surgical Prophylaxis. Antimicrob. Agents Chemother.
42: 425-427
[Abstract][Full Text]
Evans, R. S., Pestotnik, S. L., Classen, D. C., Clemmer, T. P., Weaver, L. K., Orme, J. F., Lloyd, J. F., Burke, J. P.
(1998). A Computer-Assisted Management Program for Antibiotics and Other Antiinfective Agents. NEJM
338: 232-238
[Abstract][Full Text]
Garibaldi, R. A.
(1998). Computers and the Quality of Care -- A Clinician's Perspective. NEJM
338: 259-260
[Full Text]
Fukatsu, K., Saito, H., Matsuda, T., Ikeda, S., Furukawa, S., Muto, T.
(1997). Influences of Type and Duration of Antimicrobial Prophylaxis on an Outbreak of Methicillin-Resistant Staphylococcus aureus and on the Incidence of Wound Infection. Arch Surg
132: 1320-1325
[Abstract]
Miller, R. A., Gardner, R. M.
(1997). Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems. J. Am. Med. Inform. Assoc.
4: 442-457
[Abstract][Full Text]
Hopf, H. W., Hunt, T. K., West, J. M., Blomquist, P., Goodson, W. H. III, Jensen, J. A., Jonsson, K., Paty, P. B., Rabkin, J. M., Upton, R. A., von Smitten, K., Whitney, J. D.
(1997). Wound Tissue Oxygen Tension Predicts the Risk of Wound Infection in Surgical Patients. Arch Surg
132: 997-1004
[Abstract]
Lew, D. P., Waldvogel, F. A.
(1997). Osteomyelitis. NEJM
336: 999-1007
[Full Text]
KLEINERT, J. M., HOFFMANN, J., CRAIN, G. M., LARSEN, C. F., GOLDSMITH, L. J., FIRRELL, J. C.
(1997). Postoperative Infection in a Double-Occupancy Operating Room. A Prospective Study of Two Thousand Four Hundred and Fifty-eight Procedures on the Extremities. JBJS
79: 503-13
[Abstract][Full Text]
Mossad, S. B., Serkey, J. M., Longworth, D. L., Cosgrove, D. M. III, Gordon, S. M.
(1997). Coagulase-Negative Staphylococcal Sternal Wound Infections After Open Heart Operations. Ann. Thorac. Surg.
63: 395-401
[Abstract][Full Text]
Ferro, J. F., de-Pablos, M., Logrono, M. J., Guisasola, L., Aizpuru, F.
(1997). Postoperative Contamination After Using Vancomycin and Gentamicin During Phacoemulsification. Arch Ophthalmol
115: 165-170
[Abstract]
Barie, P. S., Hydo, L. J.
(1996). Influence of Multiple Organ Dysfunction Syndrome on Duration of Critical Illness and Hospitalization. Arch Surg
131: 1318-1324
[Abstract]
Swoboda, S. M., Merz, C., Kostuik, J., Trentler, B., Lipsett, P. A.
(1996). Does Intraoperative Blood Loss Affect Antibiotic Serum and Tissue Concentrations?. Arch Surg
131: 1165-1172
[Abstract]
Blumenthal, D.
(1996). The Origins of the Quality-of-Care Debate- Part Four of Six. NEJM
335: 1146-1149
[Full Text]
Kurz, A., Sessler, D. I., Lenhardt, R., The Study of Wound Infection and, , Temperature Group,
(1996). Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization. NEJM
334: 1209-1216
[Abstract][Full Text]
HANSSEN, A. D., OSMON, D. R., NELSON, C. L.
(1996). Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Prevention of Deep Periprosthetic Joint Infection*{{dagger}}. JBJS
78: 458-71
[Full Text]
PLATT, A. J., PAGE, R. E.
(1995). Post-Operative Infection Following Hand Surgery: Guidelines for Antibiotic Use. J Hand Surg Eur Vol
20: 685-690
[Abstract]
Barber, G. R., Miransky, J., Brown, A. E., Coit, D. G., Lewis, F. M., Thaler, H. T., Kiehn, T. E., Armstrong, D.
(1995). Direct Observations of Surgical Wound Infections at a Comprehensive Cancer Center. Arch Surg
130: 1042-1047
[Abstract]
Kalish, R. L., Daley, J., Duncan, C. C., Davis, R. B., Coffman, G. A., Iezzoni, L. I.
(1995). Costs of Potential Complications of Care for Major Surgery Patients. American Journal of Medical Quality
10: 48-54
[Abstract]
Williamson, J.
(1994). Editorial: Quality of Current Diagnostic Performance--Our Most Serious Health Care Quality Problem?. American Journal of Medical Quality
9: 145-148
[Abstract]
Berwick, D. M.
(1994). Eleven Worthy Aims for Clinical Leadership of Health System Reform. JAMA
272: 797-802
[Abstract]
Bowman, M. A.
(1994). The Evolution/Revolution of Family Medicine. Arch Fam Med
3: 404-408
[Abstract]
Evans, R. S., Classen, D. C., Pestotnik, S. L., Lundsgaarde, H. P., Burke, J. P.
(1994). Improving Empiric Antibiotic Selection Using Computer Decision Support. Arch Intern Med
154: 878-884
[Abstract]
Laffel, G. L., Berwick, D. M.
(1993). Quality Health Care. JAMA
270: 254-255
[Abstract]
Blumenthal, D.
(1993). Total Quality Management and Physicians' Clinical Decisions. JAMA
269: 2775-2778
[Abstract]
Handelsman, J. C., Zeiler, S., Coleman, J., Dooley, W., Walrath, J. M.
(1993). Experience With Ambulatory Preoperative Bowel Preparation at The Johns Hopkins Hospital. Arch Surg
128: 441-444
[Abstract]
(1992). ANTIBIOTIC PROPHYLAXIS IS OPTIMAL WHEN GIVEN JUST BEFORE SURGERY. JWatch General
1992: 1-1
[Full Text]
