Peri-operative antibiotic prophylaxis in obstetrics: a 6-year evaluation of guideline adherence and stewardship impact in a Ukrainian maternity hospital

Surgical site infections are a major concern in obstetric surgery. In Ukraine, evolving national guidelines and institutional antimicrobial stewardship (AMS) initiatives have sought to optimize perioperative antibiotic prophylaxis (PAP), but their impact on clinical outcomes requires rigorous evaluation. We conducted a retrospective cohort study (2018-2023) of 474 obstetric surgeries to evaluate changes in PAP adherence and its association with length of stay. Adherence was assessed using a 3-point compliance score (timing, choice, duration). The association between compliance and time-to-discharge was analyzed using a multivariable Cox proportional hazards model. A marked improvement in practice was observed; full compliance increased from 11% to 71%, while mean length of stay decreased from 9.9 to 4.7 days. Component analysis showed that structural interventions eliminated duration errors, while errors in antibiotic choice persisted. In the multivariable model, the "year of surgery" was the strongest predictor of earlier discharge (p