In Response

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We appreciate the interest and comments from Marymont et al in response to our recent article.1 We recognize their concern regarding the potential for increased liability exposure to anesthesiologists; however, we disagree that the consensus bundle on prevention of surgical site infections after major gynecologic surgery results in increased risk to anesthesiologists.
The consensus bundle was developed by a multidisciplinary group of stakeholders from the National Council on Patient Safety in Women’s Health Care using a consensus-based feedback process. The bundle explicitly states that its primary purpose is to provide recommendations, which can be implemented into any surgical environment, in an effort to reduce the incidence of surgical site infection.2 Within each of the 4 domains (readiness, recognition and prevention, response, and reporting/systems learning), there are recommendations; however, implementation of the individual elements within the 4 domains is left to the individual institutions. The consensus bundle is not intended to be a guideline or statement of the American Society of Anesthesiologists (ASA), as ASA documents are developed and vetted through a specific process and are approved by the House of Delegates.3
Furthermore, we disagree with Marymont et al in that a single individual (ie, the surgeon) should be held responsible for determining the appropriate antibiotic and dose. While the surgeon is often responsible for initially ordering antibiotics, it is certainly within the purview of any team member who recognizes an issue with the ordered antibiotic to discuss the need for a change in the orders. As noted in the bundle, anesthesiologists often obtain a detailed history and physical on the day of the procedure and often identify issues that may require modifications to the prescribed order, such as allergies or morbid obesity.2 It is imperative that all team members feel empowered to raise safety concerns for optimizing patient outcomes. Ideally, these concerns should be discussed in the sign-in or surgical timeout.4
As anesthesiologists are playing a larger role in the perioperative care of patients,5,6 we, as a specialty, should embrace opportunities such as these to contribute to the reduction of surgical site infections through team-based applications of best practices.
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