الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Immediate postoperative period is the first 24 hours after surgery .It represents a high-risk period in developing several complications to the patient. Antibiotics, analgesics, antacids, antiemetics and anticoagulant are most commonly prescribed post operatively by general surgeons. (1, 4)
Antimicrobial agents are very important class of drugs which are essential in treating or preventing development of infections in patients. Patients in surgical wards develop infections post surgery; many of the infections are caused by bacteria that are highly virulent. As a result there is a need for prophylactic or empirical treatment with antimicrobial agents that can cover broad spectrum of pathogens. (17)Appropriateness of antibiotic prophylaxis is usually determined by the choice of antibiotics used, route of administration, timing of administration and duration of coverage as well as cost of antimicrobial regimens. While the benefits of antibiotic prophylaxis include prevention of morbidity and mortality as well as reduction in duration and cost of hospitalization, inappropriate use of antibiotic prophylaxis can have disadvantages such as the development of resistant strains. (11)
Pain control is fundamental to a rapid post-operative recovery and good quality care of a surgical patient. (31)Careful pain assessment by the surgeon or the acute pain team can lead to more efficient pain control, adequate doses of the correct drugs, and fewer post-operative complications. (34)Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in the management of acute pain after 48 hours after surgery. Opioids combined with NSAIDs can reduce the analgesic requirement of the former by 30%. (34)
Postoperative nausea and vomiting (PONV) remains one of the most common and distressing complications after surgery. It is assumed that PONV has a multifactorial origin. (43) It can cause serious complications such as esophageal rupture, pneumothorax, incisional hernia and upper airway and lung dysfunction from aspiration of vomitus. PONV may result in delayed discharge from hospital thereby increasing cost. (46)
The perioperative management of anticoagulation in patients at the time of elective surgery is very important. It involves balancing the risks of ischaemic stroke, myocardial infarction, pulmonary embolism or deep vein thrombosis if the drug is stopped, against the risk of bleeding if the anticoagulant or antiplatelet drug is continued. (49)
Perioperative management of chronic medications is a complex issue, as physicians are required to balance the beneficial and harmful effects of the individual drugs prescribed to their patients. Good preoperative medication management improves postoperative outcome. Most medications are continued in the preoperative period. (56, 57)
Only few studies were conducted on postoperative drug prescription in Egypt. No study was found in a public hospital in Alexandria until we started this study in the Medical Research Institute.
The aim of this study was to describe the antibiotics, analgesics, anticoagulants prescription within the first 24 hours after main surgeries performed in MRI, namely:, cholysystectomy, mastectomy, hernia repair and thyroidectomy surgery to discover the frequency of drug- drug interaction, to assess adherence of surgeons to current guidelines of postoperative drug prescription, and to study factors affecting non adherence.
This was a cross sectional study conducted in the surgical department of MRI through the period from July 1st 2011 till end of April 2012. Data were collected from the surgical patients’ files. Surgeries included were cholecystectomy (open and laparoscopic), mastectomy hernia repair and thyroidectomy. To determine the basis for drug prescription among surgeons a self administered questionnaire was introduced to all surgeons; residents, assistant lecturers, lecturers, assistant professors and professors.
This study showed an overall adherence to guidelines in prophylactic antibiotics prescriptions of 1.4% ranging from 66.7% in lap cholecystectomy to 7.7% in thyroidectomy, 1.6% in mastectomy and 0% in both open cholecystectomy and hernia surgeries. Adherence to postoperative analgesics prescriptions ranged from 47.8% in laparoscopic cholecystectomy to 99.4% in mastectomy. Postoperative antiemetic adherence ranged from 9.7% in mastectomy to 67.45 in laparoscopic cholecystectomy. The adherence to anticoagulants therapy varied by the risk of the patient, while it was 92% among low risk, it was only 21.2% and 15.2%among high and moderate risk groups respectively. Drug-drug interaction was detected in 80.2% of the prescriptions (significant interaction in 17.3% and serious interaction in 0.2%). None of the factors studied was significantly related to adherence to guidelines.
We conclude that there is a wide variation in prescriptions’ adherence to guidelines at the level of the different studied drugs categories as well as at the level of the different operations. Areas where patients’ risk assessment is recommended to guide the drug prescription, the risk assessment is not performed. The over prescription attitude noticed in antibiotic prescription raise concerns about antibiotic resistance and cost elevation problems. The similarity in the adherence to prescriptions’ guidelines for both junior and senior surgeons indicates that both should be targeted equally in any intervention aiming at improving prescriptions
We recommended that, there is a need to develop guidelines for surgical prophylaxis in local hospitals. The guidelines should include type of surgery, the optimal time of antibiotic administration, choice of antibiotic and an alternative, address intra-operative re-dosing and duration of use. They should also be based on hospital-specific bacterial epidemiology patterns, the best evidence derived from the literature. Guidelines for postoperative analgesics, nausea and vomiting, preoperative medication management should be considered. The support and collaboration of hospital administrators and medical staff of such guidelines is essential for their development, implementation and maintenance. It is essential for surgeons to be aware of the results of their performance about their adherence to guidelines for antibiotic prophylaxis and other medications in order to get improvement.