Pharmacist-led intervention and surgical antibiotic prophylaxis practices in total joint arthroplasty: a real-world cohort study in China

This study aimed to compare surgical antibiotic prophylaxis (SAP) practices among patients undergoing total joint arthroplasty (TJA) under two different models of pharmacist involvement within the same hospital system, using real-world clinical data. This retrospective cohort study included inpatients who underwent TJA at two orthopedic subunits of a tertiary hospital. Patients were classified into a usual care group and a pharmacist-led intervention group according to the extent of pharmacist involvement. Outcomes included key process indicators of SAP, antibiotic exposure, related costs, length of stay, and postoperative infections. Multivariable regression analyses were performed, with propensity score matching used as a sensitivity analysis. A total of 522 patients were included. Antibiotic administration within 0.5–1 h before incision was more frequent in the pharmacist-led intervention group than in the usual care group (93.41% vs. 68.79%; absolute difference: 24.62 percentage points), and the intervention was associated with higher odds of meeting this timing criterion (adjusted OR = 7.20, 95% CI: 4.06–12.74). Combined adherence to timing, antibiotic selection, and dosage was also higher in the pharmacist-led intervention group (96.85% vs. 90.75%; absolute difference: 6.10 percentage points), with higher adjusted odds of meeting this combined indicator (adjusted OR = 3.35, 95% CI: 1.45–7.78). The pharmacist-led intervention group had a shorter SAP duration (2 vs. 8 days), lower defined daily doses (2.00 vs. 8.00), and lower antibiotic costs (USD 48.06 vs. USD 193.23). The findings were generally consistent in the PSM sensitivity analysis. Overall adherence across all four dimensions was low in both groups, and no clear difference in infection outcomes was observed after matching. Length of stay was shorter in the pharmacist-led intervention group, whereas total hospitalization costs were higher. Greater pharmacist involvement was associated with improved key processes of SAP, reduced antibiotic exposure, and lower antibiotic-related costs in TJA. These findings support the integration of clinical pharmacists into perioperative antimicrobial stewardship programs to promote more appropriate antibiotic use. This study was conducted within the framework of a larger TJA research project registered in the Chinese Clinical Trial Registry (ChiCTR2100053191; registered on 14 November 2021). Overview of the study design, intervention components, and key findings. This retrospective cohort study compared perioperative surgical antibiotic prophylaxis practices between a usual care group and a pharmacist-led intervention group among patients undergoing total joint arthroplasty. SAP, surgical antibiotic prophylaxis; DDDs, defined daily doses; PSM, propensity score matching.