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Single-Dose Versus Multiple-Dose Prophylactic Antibiotics in Minimally Invasive Colorectal Surgery: A Propensity

Ga Yoon Ku1,2, Beom-Jin Kim1, Ji Won Park1,2,3

  • 1Department of Surgery, Seoul National University Hospital, Seoul, Korea.

Journal of Korean Medical Science
|December 11, 2024
PubMed
Summary

A single preoperative dose of prophylactic antibiotics is sufficient for preventing surgical site infections (SSIs) in minimally invasive colorectal cancer surgery, aligning with current guidelines and reducing unnecessary antibiotic use.

Keywords:
CefotetanMinimally Invasive Colorectal SurgeryProphylactic AntibioticsSingle Preoperative DoseSingle Preoperative Dose + Multiple Postoperative DosesSurgical Site Infection (SSI)

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Area of Science:

  • Colorectal Surgery
  • Infectious Disease Prevention
  • Surgical Oncology

Background:

  • Current guidelines suggest stopping prophylactic antibiotics post-surgery to prevent surgical site infections (SSIs).
  • Many colorectal surgeons continue prolonged antibiotic use, despite guidelines.
  • Limited research exists on optimal prophylactic antibiotic dosing for minimally invasive colorectal surgery.

Purpose of the Study:

  • To compare the efficacy of single-dose versus multiple-dose prophylactic antibiotics in preventing SSIs after minimally invasive colorectal cancer surgery.
  • To identify risk factors for SSIs in this patient population.

Main Methods:

  • Retrospective study of patients undergoing elective minimally invasive colorectal cancer surgery.
  • Comparison of SSI rates between a single preoperative dose group and a multiple-dose (preoperative plus within 24 hours post-op) group.
  • Propensity score matching (PSM) and multivariable analysis were used to control for confounding factors and identify SSI risk factors.

Main Results:

  • No significant difference in SSI rates was observed between single-dose and multiple-dose groups, both before and after PSM.
  • Multivariable analysis identified ASA class 3, rectal surgery, intraoperative transfusion, and larger tumor size as independent risk factors for SSIs.
  • Length of hospital stay was the only outcome that differed between the groups.

Conclusions:

  • A single preoperative dose of prophylactic antibiotics appears adequate for preventing SSIs in elective minimally invasive colorectal cancer surgery.
  • This finding supports de-escalation of antibiotic therapy in this surgical context.
  • Risk stratification for SSIs should consider factors like patient comorbidities, surgical site, and intraoperative events.