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Timing of Antibiotic Prophylaxis Prior to Abdominal Surgery Has No Impact on Infectious Complications: A
Kamacay Cira1, Sebastian Richter, Helmut Friess
1Department of Surgery, TUM University Hospital, Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Bavaria, Germany.
Insights
Perioperative antibiotic prophylaxis (PAP) timing did not significantly impact postoperative infections in abdominal surgery. Individualized strategies considering procedure length and resistance are suggested over rigid time adherence.
Area of Science:
- Surgical Infectious Diseases
- Antimicrobial Stewardship
- Clinical Outcomes Research
Background:
- Current guidelines recommend strict adherence to perioperative antibiotic prophylaxis (PAP) timing.
- Evidence regarding the optimal timing window for PAP remains inconclusive.
- Postoperative infectious complications are a significant concern in abdominal surgery.
Purpose of the Study:
- To evaluate the impact of perioperative antibiotic prophylaxis (PAP) timing on postoperative infectious complications.
- To assess whether PAP timing influences outcomes in elective open abdominal surgeries.
- To investigate the role of antimicrobial resistance in this association.
Main Methods:
- Retrospective matched cohort study of 1,193 patients undergoing elective open abdominal surgery.
- Categorization of PAP timing as 'on time' (OT: ≥30 min before incision) or 'not on time' (NT: <30 min before incision).
- Propensity score matching (PSM) applied to control for confounding factors; primary outcome: in-hospital infectious complications.
Main Results:
- No significant difference in infectious complications was observed between OT and NT PAP groups across different cohorts.
- Procedure duration was identified as an independent predictor of surgical site infections.
- Antimicrobial resistance did not alter the observed associations between PAP timing and outcomes.
Conclusions:
- Perioperative antibiotic prophylaxis timing does not significantly affect in-hospital infectious complications in elective open abdominal surgery.
- Antimicrobial resistance does not confound the association between PAP timing and infectious complications.
- Individualized strategies, considering procedure length and local resistance patterns, may be more beneficial than rigid time-based adherence.
Objective:
To evaluate the impact of perioperative antibiotic prophylaxis (PAP) timing on postoperative infectious complications in abdominal surgery.
Summary Background Data:
Current guidelines advocate strict adherence to predefined PAP timing, yet evidence on its optimal window remains inconclusive.
Methods:
This single-center, retrospective matched cohort study, conducted at a high-volume university hospital in Germany (2013-2018), included 1,193 patients undergoing open elective CDC II-III abdominal surgeries. PAP timing was categorized as "on time" (OT: ≥30 m before incision) or "not on time" (NT:<30 m before incision). Propensity score matching (PSM) was applied to both the real-world (RW) cohort and optimized group (10-39 m NT, or 40-69 m OT, excluding infusion time). The primary outcome was the incidence of in-hospital postoperative infectious complications.
Results:
Of 1,193 patients, 750 (62.9%) received NT and 443 (37.1%) OT-PAP. Infectious complications occurred in 196 patients (16.4%; 229 events), with 41.9% of infection-causing organisms resistant to PAP. Despite matching, differences in ASA grade, malignancy, procedure type, and duration remained. Multivariable analysis identified procedure duration as independent predictor of surgical site infections. PAP timing did not significantly affect outcomes in RW, RW-PSM, or optimized-PSM cohorts, though fewer complications occurred with OT in procedures >200 minutes. Antimicrobial resistance did not alter observed associations.
Conclusion:
PAP timing did not significantly affect in-hospital infectious complications following elective open abdominal surgery, and antimicrobial resistance did not confound this association. A rigid time-based approach may be less critical than assumed, warranting individualized strategies based on procedure length and resistance profiles.
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