Minimal Impact of Prophylactic Antibiotics in Pediatric Inguinal Hernia Surgery: Evidence From Real-World Data
Takayuki Fujii1, Yuri Kitadani2, Aya Tanaka1
1Department of Pediatric Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Mikicho, Kitagun, Kagawa 761-0793, Japan.
Insights
Prophylactic antibiotics do not reduce surgical site infections (SSIs) in pediatric inguinal hernia repair. Antibiotic use should be reserved for high-risk patients, such as those on immunosuppressants.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Clinical Outcomes Research
Background:
- The necessity of prophylactic antibiotics for pediatric inguinal hernia repair is debated, as it's a clean procedure.
- Existing evidence on antibiotic effectiveness in this pediatric population is limited.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic antibiotics in reducing surgical site infections (SSIs) after pediatric inguinal hernia repair.
- To identify risk factors associated with SSIs in this patient group.
Main Methods:
- Retrospective cohort study utilizing the TriNetX Research Network.
- Included pediatric patients (≤16 years) undergoing open or laparoscopic inguinal hernia repair (2005-2025).
- Propensity score matching used to compare outcomes between antibiotic and non-antibiotic groups, stratified by surgical approach and risk classification.
Main Results:
- Analysis of 42,779 patients showed no significant reduction in SSIs with prophylactic antibiotics for both open and laparoscopic repairs.
- SSI rates remained low (≤0.40%) in patients not receiving antibiotics, regardless of surgical approach or risk classification.
- Male sex, age < 6 months, and immunosuppressant use were identified as significant SSI predictors.
Conclusions:
- Prophylactic antibiotics do not decrease SSI rates in pediatric inguinal hernia repair.
- Antibiotic use should be limited to select high-risk pediatric patients, particularly those on immunosuppressants.
- Further research may refine antibiotic stewardship guidelines for this common pediatric surgical procedure.
Background:
The effectiveness of prophylactic antibiotics in pediatric inguinal hernia repair remains unclear. As the procedure is considered clean, the necessity of prophylactic antibiotics is debated.
Methods:
We conducted a retrospective cohort study using the TriNetX Research Network. Pediatric patients aged ≤16 years who underwent open or laparoscopic inguinal hernia repair between 2005 and 2025 were included. Patients were divided based on their receipt of prophylactic antibiotics, and separate analyses were performed based on surgical approach or risk classification. Propensity score matching was applied to balance covariates. The primary outcome was surgical site infection (SSI), and risk factors associated with SSI were evaluated.
Results:
A total of 42,779 patients were analyzed. In matched cohorts undergoing open repair (n = 2533 per group), the SSI rate was 0.43 % without antibiotics and 0.63 % with antibiotics (risk difference [RD], -0.002; 95 % CI, -0.006 to 0.002). For laparoscopic repair (n = 2516 per group), SSI rates were ≤0.40 % without and 0.56 % with antibiotics (RD, -0.002; 95 % CI, -0.005 to 0.002). Among patients who did not receive antibiotics, SSI incidence remained low for both open (0.28 %) and laparoscopic (0.27 %) repairs (n = 18,865 per group) and was comparable between high-risk (0.65 %) and average-risk (0.45 %) patients (n = 5572 per group). Cox regression identified male sex, age under 6 months, and immunosuppressant use as significant predictors.
Conclusion:
Prophylactic antibiotics did not reduce SSI in pediatric inguinal hernia repair. Their use should be limited to selected high-risk patients, such as those receiving immunosuppressants.
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