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

Ga Yoon Ku^1,2, Beom-Jin Kim¹, Ji Won Park^1,2,3

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

Journal of Korean Medical Science

|December 11, 2024

Abstract

Background:

Recent guidelines about preventing surgical site infections (SSIs) recommend against the administration of prophylactic antibiotics after surgery. However, many colorectal surgeons still prefer prolonged use of prophylactic antibiotics. While minimally invasive surgery (MIS) has become the standard for colorectal cancer surgery, there were few studies about proper dose of prophylactic antibiotics in minimally invasive colorectal surgery.

Methods:

This is a retrospective study. All patients underwent elective colorectal cancer surgery using MIS. Intravenous cefotetan was administered as a prophylactic antibiotic. Two groups were classified according to the dose of prophylactic antibiotics: a group using a single dose preoperatively (single-dose group) and a group using a preoperative single dose plus additional doses within 24 hours after surgery (multiple-dose group). The SSI rates between the two groups were compared before and after propensity score matching (PSM). Risk factors of SSIs were assessed using univariate and multivariable analysis.

Results:

There were 902 patients in the single-dose group and 330 patients in the multiple-dose group. After PSM, 320 patients were included in each group. There were no differences in baseline characteristics and surgical outcomes except the length of hospital stay. SSI rates were not different between the two groups before and after PSM (before 2.0% vs. 2.1%, P = 0.890; after 0.9% vs. 1.9%, P = 0.505). In multivariable analysis, American Society of Anesthesiologists class 3, rectal surgery, intraoperative transfusion, and larger tumor size were identified as independent factors associated with SSI incidence.

Conclusion:

A single preoperative dose of prophylactic antibiotics may be sufficient to prevent SSIs in elective MIS for colorectal cancer.

Insights

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.

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.

Read full analysis

Keywords:

Cefotetan Minimally Invasive Colorectal Surgery Prophylactic Antibiotics Single Preoperative Dose Single Preoperative Dose + Multiple Postoperative Doses Surgical Site Infection (SSI)

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