Surgery & Perioperative/Surgical prophylaxis

Surgical antibiotic & VTE prophylaxis

also: surgical antibiotic prophylaxis · VTE prophylaxis · LMWH surgery · TEDS

Overview

The two routine prophylaxis decisions around an operation — preventing surgical-site infection and preventing venous thromboembolism.

Mechanism

A single antibiotic dose at induction achieves tissue levels covering the likely skin/gut flora during the operation (not a treatment course). VTE prophylaxis combines mechanical methods with LMWH (potentiates antithrombin → ↓factor Xa).

Indications

Antibiotic prophylaxis for contaminated/prosthetic/high-risk surgery
VTE prophylaxis for surgical inpatients

The agents

Antibiotic at inductionsingle dose

within 60 min of knife-to-skin

Agent per site (e.g. cefuroxime ± metronidazole for bowel; add MRSA cover if colonised). Repeat only if long op / major blood loss.

LMWH (e.g. enoxaparin)pharmacological VTE

SC, risk-assessed

Hold around neuraxial anaesthesia timing; cross-references the Heparins card.

Mechanical (anti-embolism stockings / IPC)VTE

Use if bleeding risk high or in addition; AES contraindicated in PAD.

Adverse effects

Prophylaxis bleeding (LMWH)serious

C. difficile (broad/repeated antibiotic prophylaxis)common

Stockings: skin damage in peripheral arterial diseasecommon

Cautions & contraindications

LMWH with active bleeding / very high bleeding riskall

Use mechanical methods instead.

Anti-embolism stockings in significant peripheral arterial diseaseall

Treating prophylaxis like a treatment courseall

Antibiotic prophylaxis is a single dose at induction.

Interactions

LMWH + other anticoagulants/antiplatelets ↑bleeding

Monitoring & kinetics

VTE risk assessment for every admission; renal function for LMWH dosing

Antibiotic IV at induction; LMWH SC once daily (risk-assessed).

Source: NICE NG89 — VTE prophylaxis · SIGN — Surgical antibiotic prophylaxis