Adherence to perioperative antimicrobial prophylaxis in cancer surgeries: A single-center retrospective study from Oman

• SAP adherence was suboptimal (65.9%) in cancer surgery. • Weight-based dosing showed near-universal compliance. • Antibiotic choice, duration, and re-dosing remained suboptimal. • Prolonged procedures warrant targeted stewardship efforts. Surgical antimicrobial prophylaxis (SAP) is essential for preventing surgical site infections (SSIs), particularly in oncology patients. However, adherence to SAP guidelines globally remains inconsistent. This study evaluated adherence to SAP protocols at a tertiary oncology center and assessed associated factors with non-adherence and SSI outcomes. A retrospective review was conducted at Sultan Qaboos Comprehensive Cancer and Research Center (SQCCCRC) from August 2022 to July 2023. SAP prescriptions were evaluated for four criteria: antibiotic choice, weight-based dosing, re-dosing, and duration. Non-adherence to any of the four components considered non-adherent. Demographics, cancer type, surgical procedure, wound classification, procedure duration, SSIs, and microbiology results were extracted from patient records. We used bivariate analysis and multivariable logistic regression model to identify factors associated with non-adherence. The cumulative incidence (CI) of SSIs was also calculated. Of the 261 surgeries reviewed, overall adherence to SAP protocols was 65%. Weight-based dosing adherence was highest (99.6%), while re-dosing adherence was lowest (80 %). Univariate analyses showed non-adherence linked to higher patient weight (p=0.041), male gender (p = 0.01), wound classification (p