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Targeted antibiotic prophylaxis strategy for pancreatectomies: an analysis of the National Surgical Quality
Cynthia E Burke1, Joanna T Buchheit2, Rushin D Brahmbhatt2
1Office of Medical Education, Pennsylvania State University College of Medicine, 700 HMC Cresc Rd, Hershey, PA, USA.
Background:
Recent research supports broad-spectrum antibiotic (BSA) prophylaxis in open pancreatoduodenectomy (PD). Minimally invasive surgery (MIS) and distal pancreatectomy (DP) are associated with fewer surgical site infections (SSI), and comparatively less is known about antibiotic choice for these operations. This study seeks to define optimal antibiotic prophylaxis strategy in open and MIS PD and DP.
Methods:
PD and DP patients were identified from the 2015-2020 National Surgical Quality Improvement Program database. Baseline characteristics, antibiotic choice, and SSI rates were evaluated using univariate and multivariate analyses.
Results:
We included 19535 PDs (92.3% open, 7.7% MIS) and 10844 DPs (53% open, 47% MIS). In open PD, BSA was associated with decreased odds of SSI compared to cephalosporins (OR 0.79, 95% CI: 0.72-0.82). In MIS PD, open DP, and MIS DP, antibiotic choice was not significantly associated with SSI rates.
Conclusion:
BSA prophylaxis was associated with fewer SSI in open PD, but not MIS PD or either open or MIS DP. Routine prophylaxis with cephalosporins provides adequate coverage for these groups and overuse of BSA should be avoided.
Insights
Broad-spectrum antibiotic (BSA) prophylaxis reduced surgical site infections (SSI) in open pancreatoduodenectomy (PD). For minimally invasive surgery (MIS) PD and all distal pancreatectomy (DP) operations, BSA did not significantly impact SSI rates.
Area of Science:
- Surgical Oncology
- Infectious Disease
- Pharmacology
Background:
- Open pancreatoduodenectomy (PD) benefits from broad-spectrum antibiotic (BSA) prophylaxis.
- Minimally invasive surgery (MIS) and distal pancreatectomy (DP) have lower surgical site infection (SSI) rates.
- Optimal antibiotic prophylaxis for MIS and DP remains unclear.
Purpose of the Study:
- To determine the optimal antibiotic prophylaxis strategy for open and MIS PD and DP.
- To compare SSI rates based on antibiotic choice in different surgical approaches and procedures.
Main Methods:
- Utilized the 2015-2020 National Surgical Quality Improvement Program database.
- Analyzed baseline characteristics, antibiotic selection, and SSI rates using univariate and multivariate analyses.
- Included 19,535 PD and 10,844 DP cases.
Main Results:
- In open PD, BSA prophylaxis was linked to lower SSI odds versus cephalosporins (OR 0.79).
- No significant association between antibiotic choice and SSI rates was found for MIS PD, open DP, or MIS DP.
- Cephalosporins demonstrated adequate coverage for MIS PD and all DP procedures.
Conclusions:
- BSA prophylaxis is beneficial for open PD, reducing SSI.
- Antibiotic choice did not significantly affect SSI in MIS PD or DP (open and MIS).
- Routine cephalosporin prophylaxis is adequate for MIS PD and DP; avoid unnecessary BSA overuse.
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