2023 # AQI69 Intraoperative Antibiotic Redosing

Measure Title: Intraoperative Antibiotic Redosing

Description: Percentage of patients, aged 18 years and older, who received preoperative antibiotic prophylaxis within 60 minutes prior to incision (if fluoroquinolone or vancomycin, two hours) and undergo a procedure greater than two hours duration who received intraoperative antibiotic redosing at a maximum interval of two half-lives of the selected prophylactic antibiotic.

Denominator: 

All patients, aged 18 years and older, who received preoperative antibiotic prophylaxis within 60 minutes (if fluoroquinolone or vancomycin, two hours) prior to incision and undergo a procedure greater than two hours duration.

Denominator Definition:

For the purpose of this measure, preoperative antibiotic prophylaxis includes,but is not limited to, prophylaxis with the following antimicrobial agents:

·         Ampicillin-sulbactam

·         Ampicillin

·         Aztreonam

·         Cefazolin

·         Cefuroxime

·         Cefotaxime

·         Cefoxitin

·         Cefotetan

·         Clindamycin

·         Piperacillin-tazobactam

Denominator Criteria (Eligible Cases):

All patients, aged 18 years and older

AND

Patient received antibiotic prophylaxis within 60 minutes (if fluoroquinolone or vancomycin, two hours) prior to incision:10A87

AND

Procedure >2 hours duration [11A60]           

AND

Patient encounter during the reporting period (CPT):
00100, 00102, 00103, 00120, 00124, 00126, 00140, 00144, 00145, 00147, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00454, 00470, 00472, 00474, 00500, 00528, 00529, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00562, 00563, 00566, 00567, 00580, 00600, 00604, 00620, 00625, 00626, 00630, 00632, 00635, 00640, 00670, 00700, 00730, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00811, 00820, 00830, 00832, 00840, 00842, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01120, 01140, 01150, 01160, 01170, 01173, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01340, 01360, 01382, 01390, 01392, 01400, 01402, 01404, 01430, 01432, 01440, 01442, 01444, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01500, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01710, 01712, 01714, 01716, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01920, 01924, 01925, 01926, 01930, 01931, 01932, 01933, 01937, 01938, 01939, 01940, 01941, 01942, 01951, 01952, 01961, 01962, 01963, 01965, 01966.

Numerator: 

Patients who received intraoperative redosing of prophylactic antibiotics at a maximum interval of two half-lives of the selected prophylactic antibiotic

Numerator Note: If multiple redosing windows pass during a procedure, the recommended redosing window is the maximum amount of time that can pass between any two doses in order to meet this measure. Information on dosing and redosing should reflect clinical practice guidelines, local hospital policy, manufacturer guidance, and other materials imperative to safe practice. Antibiotic redosing should occur prior to closing the surgical incision.

Maximum redosing intervals for included antibiotics are listed below:[3]

·         Ampicillin-sulbactam: 2 hours

·         Ampicillin: 2 hours

·         Aztreonam: 4 hours

·         Cefazolin: 4 hours

·         Cefuroxime: 4 hours

·         Cefotaxime: 3 hours

·         Cefoxitin: 2 hours

·         Cefotetan: 6 hours

·         Clindamycin: 6 hours

·         Piperacillin-tazobactam: 2 hours

Denominator Exclusions: 

·      Acute Renal failure [11A61]

·      Chronic kidney disease [11A62]

·      Procedure duration <2 half-lives of selected prophylactic antibiotic [11A63]

Denominator Exceptions: None

 National Quality Forum (NQF) number, if applicable
N/A

Care setting(s) 
Hospital

Telehealth, if applicable
No

Number of performance rates required for measures
1

Traditional vs. inverse measure
Traditional

Proportional, continuous variable, and/or ratio measure indicator
Proportional

Risk adjustment, if applicable
No

Submission pathway 
Traditional MIPS, MVP