Antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial

Area of Science:

• Surgical Oncology
• Infectious Diseases
• Health Economics

Background:

• Existing meta-analyses suggest antibiotic prophylaxis is unnecessary for low-risk laparoscopic cholecystectomy.
• However, these analyses were limited by small sample sizes and statistical underpowering.
• The cost-effectiveness of eliminating prophylactic antibiotics has not been statistically evaluated.

Purpose of the Study:

• To conduct a randomized controlled trial (RCT) evaluating the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy.
• To assess the impact of prophylactic antibiotics on postoperative infection rates.
• To determine the effect on postoperative hospital stay and medical costs.

Main Methods:

• An RCT involving patients scheduled for elective laparoscopic cholecystectomy from March 2007 to May 2013.
• Patients were randomized into two groups: one receiving prophylactic antibiotics and the other not.
• Primary endpoint: postoperative infection occurrence; Secondary endpoints: postoperative hospital stay and medical costs.

Main Results:

• A significantly lower incidence of surgical site infections (0.8% vs. 3.7%), distant infections (0.4% vs. 3.1%), and overall infections (1.2% vs. 6.7%) in the antibiotic group.
• The antibiotic group experienced a shorter postoperative hospital stay (mean 3.69 days vs. 4.07 days).
• Medical costs were significantly lower in the antibiotic group ($766 vs. $832).
• Independent risk factors for infection included no prophylactic antibiotics and age ≥65.

Conclusions:

• Perioperative prophylactic antibiotics are recommended for laparoscopic cholecystectomy.
• Antibiotic use effectively prevents postoperative infectious complications.
• Prophylactic antibiotics also contribute to reducing overall medical costs.