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Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective
Gil Rodríguez-Caravaca1, Pablo Gil-Yonte2, Carlos Risco-Risco3
1Medicina Preventiva y Salud Pública, Hospital Universitario Fundación Alcorcón. Alcorcón, Madrid, ESPAÑA.
Insights
Adherence to antibiotic prophylaxis protocols for cholecystectomy was high at 72%. However, this adherence did not significantly impact surgical infection rates in patients undergoing gallbladder removal.
Area of Science:
- Surgical Infection Prevention
- Antibiotic Prophylaxis Guidelines
- Gallbladder Surgery Outcomes
Background:
- Antibiotic prophylaxis is standard for reducing surgical site infections.
- Its use in cholecystectomy, particularly for non-high-risk patients, remains debated.
- This study assesses adherence to antibiotic prophylaxis protocols and its effect on infection rates in cholecystectomy patients.
Purpose of the Study:
- To evaluate adherence to the hospital's antibiotic prophylaxis protocol for cholecystectomy.
- To determine the impact of this adherence on surgical infection outcomes.
Main Methods:
- A single-center, observational, retrospective study of elective cholecystectomies from 2007-2014.
- Hospital records were reviewed to assess adherence to antibiotic choice, timing, duration, route, and dosage.
- Surgical infection rates were compared between laparoscopic and open cholecystectomy and correlated with prophylaxis adequacy.
Main Results:
- Overall protocol adherence was 72%, with 100% adherence for administration route and dose.
- Most common deviations involved antibiotic choice (19%) and initiation timing (8.9%).
- No significant association was found between antibiotic prophylaxis adequacy and surgical infection rates, regardless of surgical approach (laparoscopy vs. laparotomy).
Conclusions:
- The hospital demonstrated a high rate of adherence (72%) to its antibiotic prophylaxis protocol for elective cholecystectomy.
- Adequacy of antibiotic prophylaxis was not significantly associated with surgical infection rates in this patient cohort.
Background:
Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection.
Methods:
This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis.
Results:
The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1).
Conclusions:
The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.
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