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Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk?
Hyung Jin Kim1, Sung Hwa Kang1, Young Hoon Roh1
1Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
Purpose:
The average rate of surgical site infections (SSIs) for laparoscopic cholecystectomy (LC) has been reported in the literature to be between 0.4% and 6.3%. Also, these recent reviews have concluded that a prophylactic antibiotics for elective LCs in low-risk patients is not useful, but there were no results in high-risk patients.
Methods:
The aim of this study was to investigate the role of a single dose of first-generation cephalosporin as a prophylactic antibiotic for patients undergoing elective LC, regardless of patient risk. This randomized clinical trial was conducted from October 2013 to December 2014 by single surgeon at our hospital. Patients were randomized into two groups by following method. Odd-numbered patients (group A) received 1-g cefazolin intravenously within 30 minutes before incision, whereas even-numbered patients (group B) received normal saline intravenously instead of prophylactic antibiotics, with the aim of including 100 patients in each group. SSIs were recorded and compared between the groups.
Results:
There were no differences in preoperative demographics and postoperative findings between the groups. There were no superficial and deep SSIs in either group, 9 cases of superficial seromas developed (4.5%) in the cohort: 4 in group A (4%) and 5 in group B (5%). There were no significant associations between SSIs and the use of prophylactic antibiotics in either group. Additionally, the high-risk group did not show a significantly increased rate of SSIs.
Conclusion:
Based on our study, prophylactic antibiotics are not necessary in elective LC, regardless of patient risk.
Insights
Prophylactic antibiotics are not necessary for patients undergoing elective laparoscopic cholecystectomy (LC), regardless of their risk factors. This study found no significant difference in surgical site infections (SSIs) between groups receiving antibiotics and those receiving a placebo.
Area of Science:
- Surgical Oncology
- Infectious Disease Prevention
- Gastrointestinal Surgery
Background:
- Surgical site infections (SSIs) following laparoscopic cholecystectomy (LC) range from 0.4% to 6.3%.
- Previous reviews suggest prophylactic antibiotics are not beneficial for low-risk patients undergoing elective LC, but evidence for high-risk patients is lacking.
Purpose of the Study:
- To evaluate the efficacy of a single dose of first-generation cephalosporin as a prophylactic antibiotic for elective LC.
- To determine if prophylactic antibiotics are necessary for all patients, irrespective of their risk profile.
Main Methods:
- A randomized clinical trial involving 100 patients per group.
- Group A received intravenous cefazolin; Group B received intravenous normal saline.
- Patients were stratified by risk, and SSIs were monitored postoperatively.
Main Results:
- No significant differences in demographics or postoperative outcomes were observed between the groups.
- No superficial or deep SSIs occurred in either group.
- Superficial seromas developed in 4.5% of patients (4% in the antibiotic group, 5% in the placebo group) with no significant association with antibiotic use.
Conclusions:
- Prophylactic antibiotics are not indicated for elective laparoscopic cholecystectomy.
- The use of prophylactic antibiotics does not reduce SSI rates in elective LC, even in high-risk patients.
