Thoracic surgeons’ practice and attitude towards surgical antimicrobial prophylaxis in VATS lung surgery: A survey within a large medical consortium

BACKGROUND AND OBJECTIVES: Surgical site infections (SSIs) are a significant post-surgery complication, impacting mortality, morbidity, and healthcare costs. Surgical antimicrobial prophylaxis (SAP) is pivotal in SSIs prevention. This study aimed to evaluate the current use of SAP in video-assisted thoracoscopic surgery (VATS) lung surgery in China. METHODS: A descriptive, cross-sectional survey study was conducted among thoracic surgeons within a large medical consortium in order to assess their practice and attitude about SAP. A three-section multiple-choice online questionnaire was designed and distributed via WeChat software to thoracic surgeons. The surgeons' answers were considered consistent when they were in accordance to clinical guidelines. RESULTS: 89 thoracic surgeons were requested to participate in this study and their response rate was 73.03%. Preoperatively, 60.00% administered antimicrobials, predominantly within 0.5 to 1 hour before surgery, with cefuroxime as the preferred agent. Intraoperatively, 32.31% did not administer additional antimicrobials, and postoperatively, 90.77% prescribed them, often continuing until drainage tube removal. Surgeons frequently upgraded prophylaxis, especially postoperatively. Deviations from guidelines were common, particularly in postoperative SAP duration (76.92%), intraoperative redosing decisions (58.33%), and preoperative SAP administration (40.00%). Departmental habits significantly influenced SAP practices. The primary reason for inconsistencies was the absence of patient-specific considerations in the guidelines, affecting nearly half of the cases. Experienced surgeons were more likely to cite this lack of patient-specific attention as a reason for deviation. CONCLUSION: The study underscores the need for updated, multidisciplinary guidelines for VATS lung surgery, emphasizing the importance of a collaborative approach among healthcare professionals to optimize individualized SAP.