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Evidence-based practice in laparoscopic surgery: perioperative care
Aaron Goldfaden1, John D Birkmeyer
1Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan and Department of Surgery, St. Joseph Medical Center, Ann Arbor, MI 48109, USA.
Surgical Innovation
|April 23, 2005
Summary
For laparoscopic surgery patients, routine antibiotics and venous thromboembolism prophylaxis may not be necessary. Serotonin receptor antagonists are recommended for preventing postoperative nausea and vomiting.
Area of Science:
- Surgical outcomes
- Evidence-based medicine
- Perioperative care
Background:
- Uncertainty exists regarding best practices for managing postoperative infection, venous thromboembolism (VTE), and nausea and vomiting (NVP) in laparoscopic surgery.
- This uncertainty leads to wide variations in perioperative care protocols.
- Evidence from randomized clinical trials (RCTs) is needed to guide practice.
Purpose of the Study:
- To review evidence from RCTs on the effectiveness of interventions for reducing postoperative infection, VTE, and NVP in patients undergoing laparoscopic surgery.
- To provide evidence-based recommendations for perioperative care in laparoscopic procedures.
Main Methods:
- Systematic review of RCTs published in English since 1990.
- Searched Cochrane Central Register of Clinical Trials and reference lists of relevant trials.
- Included trials focused specifically on patients undergoing laparoscopic surgery.
- Analyzed data from 98 RCTs.
Main Results:
- Routine antibiotic use is likely unnecessary for clean laparoscopic procedures without prosthesis placement (e.g., cholecystectomy).
- Venous thromboembolism prophylaxis is probably not required for low-risk patients undergoing short laparoscopic procedures.
- Serotonin receptor antagonists are the most effective agents for routine prophylaxis of postoperative nausea and vomiting.
Conclusions:
- Evidence suggests de-escalation of antibiotic use and judicious application of VTE prophylaxis in select laparoscopic surgery patients.
- Serotonin receptor antagonists should be considered for routine prophylaxis to manage postoperative nausea and vomiting effectively.
- These findings can help standardize and improve perioperative care in laparoscopic surgery.