{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:01:28Z","timestamp":1787018488384,"version":"build-2736575974"},"reference-count":14,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic misuse extends beyond clinical outcomes, imposing significant financial, operational, and environmental burdens on health care systems. Despite guidelines advising against antibiotic prophylaxis for elective low-risk laparoscopic operations, clean head and neck, and soft tissue procedures, many surgeons continue to use them. We performed a cost and environmental waste analysis at our institution resulting from nonadherence to guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was performed at a single institution between January 2022 and March 2023. All patients undergoing elective diagnostic laparoscopy, soft tissue excisions for presumed benign disease, thyroid, and parathyroidectomy operations were included. Antibiotic costs were obtained from the hospital charge pharmacy. Waste was estimated by weighing the bottles and syringes used to administer the antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From January 2022 to March 2023, 137 patients who underwent the defined operations were identified. 38% (n = 52) underwent lipoma excisions, 33% (n = 46) thyroidectomy, 11% (n = 15) parathyroidectomy, 9% (n = 12) diagnostic laparoscopy, and 9% (n = 12) other soft tissue excision. 94% (n = 129) of cases were classified as clean and 6% (n = 8) were classified as clean-contaminated in the operative report. Prophylactic antibiotics were administered to 92% (n = 126) of patients, with 6% (n = 8) receiving an additional intraoperative dose. Cefazolin was used in 90% (n = 119) of cases, followed by Cefoxitin 1% (n = 1) and Clindamycin 1% (n = 1). Adherence to guidelines could have saved US$3279 and prevented \u00a323 of waste.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A significant number of clean cases received prophylactic antibiotics, reflecting poor adherence to clinical practice guidelines. Improving antibiotic stewardship can reduce costs and environmental waste.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251355936","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T02:46:17Z","timestamp":1750992377000},"page":"1749-1753","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Less is More: A Cost and Environmental Waste Analysis in Nonadherence to Antibiotic Prophylaxis Guidelines in Clean Ambulatory Surgical Procedures"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1481-3753","authenticated-orcid":false,"given":"Isabela","family":"Sandigo-Saballos","sequence":"first","affiliation":[{"name":"Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7185-4797","authenticated-orcid":false,"given":"Stefania","family":"Montero","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Internal Medicine, Harbor UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanjoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn T.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harbor UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclepro.2018.11.204"},{"key":"e_1_3_3_3_2","volume-title":"Safe Management of Wastes from health-care Activities","author":"World Health Organization","year":"2014","unstructured":"World Health Organization. Safe Management of Wastes from health-care Activities (Yves Chartier, Jorge Emmanuel, Ute Pieper A. P., Philip Rushbrook, Ruth Stringer, William Townend, & Susan Wilburn and Raki Zghondi, Eds 2nd ed.); 2014.","edition":"2"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01247"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp120568"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.18.00168"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2023.04.071"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-018-9498-8"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cej.2024.155372"},{"key":"e_1_3_3_10_2","unstructured":"UN News\/Laura Qui\u00f1ones. World Must \u2018Work as One\u2019 to End Plastic Pollution: Guterres United Nations; 2023."},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2309822"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/175045891302300605"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6060(05)80044-3"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11030290"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/11786329211070722"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251355936","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251355936","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251355936","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:06Z","timestamp":1777379886000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251355936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":14,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/00031348251355936"],"URL":"https:\/\/doi.org\/10.1177\/00031348251355936","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]}}}