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Surgical Antimicrobial Prophylaxis in Low-risk Cholecystectomies is Associated With Fewer Surgical Site Infections:

Lena Florinett1, Andreas Widmer2,3, Nicolas Troillet3,4

  • 1Department of Medicine and Medical Sciences, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.

Annals of Surgery
|June 17, 2024
PubMed

Insights

Surgical antimicrobial prophylaxis (SAP) significantly reduced surgical site infections (SSI) in low-risk cholecystectomies (LR-CCE). This study suggests routine SAP may benefit patients undergoing LR-CCE, despite current guidelines.

Area of Science:

  • Surgical prophylaxis and infection control
  • Gastrointestinal surgery outcomes
  • Epidemiology of surgical site infections

Background:

  • Current guidelines do not recommend routine surgical antimicrobial prophylaxis (SAP) for low-risk cholecystectomies (LR-CCE).
  • Evidence regarding the efficacy of SAP in LR-CCE is limited.
  • Optimizing infection prevention strategies in elective surgical procedures is crucial.

Purpose of the Study:

  • To evaluate the association between surgical antimicrobial prophylaxis (SAP) and the risk of surgical site infections (SSI) after low-risk cholecystectomies (LR-CCE).
  • To determine if SAP administration decreases SSI rates in a specific patient cohort.
  • To inform clinical practice regarding SAP use in elective gallbladder surgery.

Main Methods:

  • A cohort study analyzed data from 44,682 cholecystectomy patients, focusing on 12,521 meeting LR-CCE criteria (elective, age <70, no active cholecystitis, ASA <3, operating time <120 min, no foreign material).
  • Exposure was defined as administration of cefuroxime or cefazoline ± metronidazole within 120 minutes before incision versus no SAP.
  • Logistic regression models adjusted for institutional, patient, and perioperative factors to assess SSI occurrence by day 30.

Main Results:

  • The overall surgical site infection (SSI) rate in low-risk cholecystectomies (LR-CCE) was 1.1% (143/12,521 patients).
  • Surgical antimicrobial prophylaxis (SAP) administration was associated with a significantly lower SSI rate (adjusted odds ratio [aOR], 0.50; P < 0.001).
  • The number needed to treat with SAP to prevent one SSI episode was 100 patients.

Conclusions:

  • Surgical antimicrobial prophylaxis (SAP) was associated with a 50% reduction in surgical site infections (SSI) after low-risk cholecystectomies (LR-CCE).
  • The findings suggest that patients undergoing LR-CCE may benefit from routine SAP.
  • This study provides evidence to potentially revise current guidelines on SAP for LR-CCE.
Abstract

Keywords:
cephalosporinelow-risk cholecystectomysurgical antimicrobial prophylaxissurgical site infectionsurveillance

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