Antibiotic Prophylaxis for Elective Pediatric Laparoscopic Cholecystectomies

Area of Science:

• Pediatric surgery
• Infectious disease
• Surgical quality improvement

Background:

• Current Surgical Infection Society (SIS) guidelines advise against surgical antibiotic prophylaxis (SAP) for low-risk patients undergoing elective laparoscopic cholecystectomies.
• However, adherence to these guidelines in clinical practice for pediatric patients remains unclear.

Purpose of the Study:

• To evaluate the impact of SAP on surgical site infection (SSI) rates in pediatric patients undergoing elective laparoscopic cholecystectomy.
• To assess current hospital compliance with SIS guidelines regarding SAP for this patient population.

Main Methods:

• A retrospective comparative study utilizing the National Surgical Quality Improvement Program (NSQIP) database.
• Analysis included 3959 pediatric patients who underwent elective laparoscopic cholecystectomy between 2021 and 2022, with specific exclusion criteria applied.
• Patients were stratified based on whether they received SAP or not.

Main Results:

• The majority of patients (90.2%) received SAP, indicating potential non-compliance with SIS guidelines.
• Patients who did not receive SAP had significantly higher incidences of superficial incisional SSI (2.1% vs. 0.8%) and organ space SSI (0.8% vs. 0.1%).
• Multivariable analysis confirmed that receiving SAP was associated with a significantly lower likelihood of any postoperative SSI (OR = 0.35).

Conclusions:

• Hospitals are not consistently following SIS guidelines for omitting SAP in low-risk pediatric laparoscopic cholecystectomy patients.
• The findings suggest that SAP may reduce SSI rates in this population.
• Further studies and a reassessment of current SIS guidelines for pediatric patients are warranted.