Antibiotics for Groin Hernia Repair According to Evidence-Based Guidelines: Time for Action in Ghana.
BACKGROUD
Groin hernia repairs (GHR), though classified as clean surgeries, are associated with varying rates of surgical site infections. We assessed the practices of surgeons in Ghana regarding antibiotic use for GHR in comparison to evidence-based international guidelines (EBIG).


METHODS
We interviewed surgeons trained by the Ghana College of Physicians and Surgeons (GCPS), from inception (2003) through 2016, about their use of antibiotics for GHR. We defined the outcome variable of consistently following EBIG in antibiotics use for GHR. Logistic regression was used to examine how a priori selected covariates contributed to the outcome.


RESULTS
Eighty-two of 117 surgeons reported performing/supervising at least one GHR per week. They performed/supervised a mean of five GHR per week. Thirty-two (40%) reported using mesh for at least 50% of GHR. For primary GHR, 75% of surgeons administered antibiotics according to EBIG, whereas for GHR with mesh only, 45% did so. Predictors of consistently following EBIG were increasing number of GHR performed per week (adjusted odds ratio 1.44, 95% CI 1.07-1.96) and increasing time spent for clinical work (adjusted odds ratio 0.95, 95% CI 0.91-0.99). Years of practice since GCPS graduation, total operations performed per week, and hospital level of practice were not predictive of the outcome variable.


CONCLUSIONS
Two-thirds of Ghanaian surgeons interviewed do not consistently administer antibiotics for GHR per EBIG, raising the need to improve access to evidence-based medical information overall to guide practice. Determining local surgical site infections rates to guide antibiotic use in GHR will be useful in Ghana and other LMICs.
['Gyedu|Adam|A|', 'Katz|Micah|M|', 'Agbedinu|Kwabena|K|', 'Donkor|Peter|P|', 'Mock|Charles|C|']
D000328:Adult D000900:Anti-Bacterial Agents D019072:Antibiotic Prophylaxis D019317:Evidence-Based Medicine D005260:Female D005869:Ghana D006552:Hernia, Inguinal D059685:Herniorrhaphy D006801:Humans D008297:Male D008875:Middle Aged D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D066231:Surgeons D013530:Surgical Wound Infection
Antibiotics Groin hernia repair Ghana Low- and middle-income country