Applying Value-Based Healthcare Principles in Optimizing Post-Operative Oral Antibiotic Prophylaxis: A Pre-Post Intervention Study in a Single Center in Saudi Arabia

Sara A Youssef,1 Karemah S Alshurtan,2 Reem M Alodayli,1 Haytham M Alzinati,3 Shahad Y Mustafa4 1Department of Pharmaceutical Care, Saudi German Hospital, Hail, 55481, Saudi Arabia; 2Department of Internal Medicine and Adult Critical Care, College of Medicine, University of Hail, Hail, 81422, Saudi Arabia; 3Department of General Surgery, Saudi German Hospital, Hail, 55481, Saudi Arabia; 4College of Medicine, Sulaiman Al Rajhi University, Al Bukaryriyah, 51941, Saudi ArabiaCorrespondence: Sara A Youssef, Department of Pharmaceutical Care, Saudi German Hospital, Hail, 55481, Saudi Arabia, Email [email protected]: Routinely continuing postoperative antibiotic prophylaxis beyond 24 hours runs against global standards and increases the risk of antimicrobial resistance (AMR). This study explored the effect of Value-Based Healthcare (VBHC)-influenced antimicrobial stewardship program (ASP) activities on postoperative oral antibiotic prescription at a tertiary hospital in Saudi Arabia. The Health Sector Transformation Program aims to shift the healthcare service in Saudi Arabia to value-based service by implementation of VBHC models. The intervention performed in SGH-Hail support the Vision 2030 objective of Saudi Arabia. VBHC is based on the premise that healthcare value should be measured by the health outcomes achieved relative to the cost (in dollars) incurred rather than by the number of services (volume) delivered.Methods: This pre-post design intervention study was conducted at the Saudi German Hospital in Hail. Data were obtained from all surgical patients (elective and emergency, analyzed jointly) both pre- and post-implementation of a fully VBHC-focused stewardship program that included educational activities, mandatory documentation, prospective audits and feedback, clinical decision support, and multidisciplinary stewardship. The primary outcome was the proportion of patients who received postoperative oral antibiotics beyond 24 hours of prophylaxis. Effect sizes were quantified using the Odds Ratio (OR) and Absolute Risk Reduction (ARR) with 95% confidence intervals.Results: A total of 4,103 surgical patients were analyzed (pre-VBHC: n=633; post-VBHC: n=3,470). Post-operative antibiotic prescribing decreased significantly from 75.9% to 15.9% following implementation (p< 0.001), with an OR of 0.060 (95% CI: 0.049– 0.074) and an ARR of 60.0 percentage points. Documentation of clinical justification improved from 1.0% to 88.6% (p< 0.001). The intervention effect was consistent across all major surgical departments (all p< 0.001) and both genders. Surgical site infection rates remained below institutional and international benchmarks throughout the study period.Conclusion: The application of VBHC principles led to a clinically and statistically significant reduction in unnecessary postoperative antibiotic prescriptions (OR 0.060; ARR 60.0 percentage points) and a marked increase in guideline compliance. The components of this intervention provide a framework that other healthcare organizations can implement to make surgical prophylaxis practices evidence-informed.Keywords: value-based healthcare, surgical prophylaxis, postoperative antibiotics, antimicrobial stewardship, quality improvement, Saudi Arabia