EP 179 Closed Loop Audit of Prophylactic Antibiotic Practices in Ventral Hernia Repair According to the Local Hospital Guidelines

Background

The European and British Hernia Societies do not recommend routine preoperative antibiotic prophylaxis for elective ventral hernia repair; however, prophylaxis is advised for high-risk patients undergoing mesh repair. In line with this, our hospital guideline recommends antibiotic prophylaxis only for high-risk mesh patients using the standard hospital-recommended regimen. This audit assessed adherence to this guideline and the impact of educational interventions.

Methods

The first cycle included 59 patients undergoing elective ventral hernia repair over six months. Data collected included demographics, operative approach, repair type, risk status, antibiotic use, and guideline adherence. Following departmental presentation of findings and distribution of educational posters, a second cycle was completed including 15 patients over one month.

Results

In the first cycle, suture repair was performed in 26 patients and mesh repair in 33, including 23 high-risk cases. Antibiotics were prescribed unnecessarily in 35.6% of patients. Only 1 of 23 high-risk mesh patients received guideline-recommended prophylaxis, resulting in overall compliance of 27.1%.

In the second cycle, mesh repair was performed in 13 patients and suture repair in 2. One of ten high-risk mesh patients received a non-guideline regimen, while two of four low-risk patients received unnecessary prophylaxis. Overall guideline adherence increased to 80%, with 90.9% compliance among high-risk mesh patients.

Conclusion

Initial adherence to local antibiotic prophylaxis guideline for ventral hernia repair was poor, with both overuse and inappropriate antibiotic selection. Educational interventions led to a marked improvement in compliance. Ongoing education and periodic re-audit are recommended to sustain improvement and support antimicrobial stewardship.