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Chaochankit W, Samphao S, Mahattanobon S, Sungworawongpana C. Clinical Predictive Score for Cholecystectomy Wound Infection: WEBAC Score. J Gastrointest Surg 2023; 27:1876-1882. [PMID: 37340105 DOI: 10.1007/s11605-023-05750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Most common surgical complications in cholecystectomy are surgical site infections (SSIs). SSIs have many factors, including patient, surgical, and disease factors. This study aims to find the factors which relate to SSIs 30 days after cholecystectomy and contribute to the scoring system to predict SSIs. METHODS AND MATERIAL The data of patients who underwent cholecystectomy from January 2015 to December 2019 were retrospectively collected from a prospectively collected infectious control registry. The SSI was defined following the CDC criteria and assessed before discharge and at a 1-month follow-up. Variables that were independently predictive of the increased SSIs were included in the risk score. RESULTS The patients who underwent cholecystectomy were 949, which were divided into 28 patients who had SSIs and 921 who had no SSIs. The rate of SSIs was 3%. The factors related to SSI in cholecystectomy were age ≥ 60 years (p = 0.045), history of smoking (p = 0.004), retrieval bag use (p = 0.005), preoperative ERCP (p = 0.02), and wound class III and IV (p = 0.007). Risk assessment was using five variables (WEBAC): (1) wound classifications, (2) preoperative ERCP, (3) retrieval plastic bag use, (4) aged ≥ 60 years, and (5) history of smoking (cigarette). If patients were aged ≥ 60 years and had a history of smoking, no plastic bag use, preoperative ERCP, or wound class III or IV, these parameters would all be scored 1 each. The WEBAC score revealed the probability of SSIs in cholecystectomy wounds. CONCLUSION The WEBAC score represents a convenient and simple tool to predict the probability of SSI in the patients who underwent cholecystectomy and might increase the surgeons' awareness of postoperative SSI.
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Affiliation(s)
- Wongsakorn Chaochankit
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Srila Samphao
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Somrit Mahattanobon
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chutida Sungworawongpana
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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2
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Dai L, Jin X, Xie H, He T, Cheng H, Zhu Y, Wang L, Huang F, Liang B, Gou X, Wang Q, Wang H. The effect of antibiotic prophylaxis on the incidence of surgical site infection after laparoscopic appendectomy for chronic appendicitis. Heliyon 2023; 9:e15578. [PMID: 37153397 PMCID: PMC10160511 DOI: 10.1016/j.heliyon.2023.e15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
Background The guidelinesthat specify whether antibiotic prophylaxis should be administered before laparoscopic clean-contaminated wound to prevent postoperative surgical site infection (SSI) need to be improved. Studies have shown that elective laparoscopic cholecystectomy with clean-contaminated wound does not require antibiotic prophylaxis. However, there are no studies on the effect of antibiotic prophylaxis on SSI after laparoscopic appendectomy for chronic appendicitis (LCA), which is a clean-contaminated wound. Methods We conducted a single-center, double-blind, randomized controlled clinical trial. A total of 106 effective patients were randomly divided into the antibiotic group and saline group. Cefuroxime or clindamycin was administered intravenously in the antibiotic group (n = 52). Saline (0.9%) was administered intravenously in the saline group (n = 54). Interventions were administered as a single dose 30 min before surgery. Results Among the 106 effective patients (median age, 37 years old [IQR, 25-45]; females, 77 [72.6%]), there were 6 cases (5.70%) of SSI: 3 cases (5.56%) in the saline group and 3 cases (5.70%) in the antibiotic group (OR = 1.00, [95% CI (0.20-5.4)], P = 0.96). There were no significant differences in the clinical outcomes of anal exhaust time, postoperative complications, and the symptom of primary abdominal pain between the two groups. Conclusion For patients with chronic appendicitis undergoing laparoscopic appendectomy, preoperative intravenous antibiotic prophylaxis did not reduce the risk of SSI within 30 days of the surgery compared to the saline group. Trial registration Registration number of China Clinical Trials Registration Center: ChiCTR2100048336.
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Affiliation(s)
- Li Dai
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Xiangren Jin
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Haitao Xie
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Tong He
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Honggang Cheng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yinwu Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Liuxing Wang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Fu Huang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Baichuang Liang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Xin Gou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Qian Wang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
| | - Haibin Wang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, People's Republic of China
- Corresponding author.
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Tracy BM, Valdez CL, Paterson CW, Hochman BR, Kwon E, Sims CA, Rattan R, Dante Yeh D, Gelbard RB. Broad vs Narrow Spectrum Antibiotics in Common Bile Duct Stones: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Study. J Am Coll Surg 2022; 235:411-419. [PMID: 35972159 DOI: 10.1097/xcs.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy. STUDY DESIGN We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019. We excluded patients with cholangitis, perforated cholecystitis, and nonbiliary infections on admission. Patients were divided based on receipt of BS or NS antibiotics. Our primary outcome was the incidence of SSIs, and secondary outcomes included hospital length of stay, acute kidney injury (AKI), and 30-day readmission for SSI. RESULTS The cohort had 891 patients: 51.7% (n= 461) received BS antibiotics and 48.3% (n = 430) received NS antibiotics. Overall antibiotic duration was longer in the BS group than in the NS group (6 vs 4 d, p = 0.01); however, there was no difference in rates of SSI (0.9% vs 0.5%, p = 0.7) or 30-day readmission for SSI (1.1% vs 1.2%, p = 1.0). Hospital length of stay was significantly longer in the BS group (p < 0.001) as were rates of AKI (5% vs 1.4%, p = 0.001). On multivariable regression, BS antibiotic use was a risk factor for AKI (adjusted odds ratio 2.8, 95% CI 1.16 to 7.82, p = 0.02). CONCLUSION The incidence of SSI and 30-day readmission for SSI was similar between antibiotic groups. However, BS antibiotic use was associated with a longer hospitalization and greater likelihood of AKI.
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Affiliation(s)
- Brett M Tracy
- From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Tracy, Valdez, Sims)
| | - Carrie L Valdez
- From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Tracy, Valdez, Sims)
| | - Cameron W Paterson
- Department of Surgery, Emory University School of Medicine, Atlanta, GA (Paterson)
| | - Beth R Hochman
- Department of Surgery, Columbia University Irving Medical Center, New York NY (Hochman)
| | - Eugenia Kwon
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA (Kwon)
| | - Carrie A Sims
- From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Tracy, Valdez, Sims)
| | - Rishi Rattan
- Department of Surgery, University of Miami, Miami, FL (Rattan, Yeh)
| | - D Dante Yeh
- Department of Surgery, University of Miami, Miami, FL (Rattan, Yeh)
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Gelbard)
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Lim CY, Alonso A, Koh YY, Roydhouse S, McCormack L, Deans R, Nesbitt-Hawes E, Rao A, Causer L, Abbott JA. A Double-Blinded, Randomised, Placebo-Controlled Trial of Antibiotic Prophylaxis in Elective Non-Hysterectomy Laparoscopic Surgery for Benign Gynaecological Conditions: A Pilot Study. J Minim Invasive Gynecol 2022; 29:992-997. [PMID: 35513301 DOI: 10.1016/j.jmig.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To determine the feasibility of a double-blinded randomised, placebo-controlled study in determining the efficacy of antibiotic prophylaxis in preventing postoperative infections (POI) in elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions. DESIGN Double-blinded, randomised, placebo-controlled trial. SETTING University-affiliated tertiary referral hospital in Sydney, Australia. PATIENTS Women over the age of 18 undergoing elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions were eligible for the study and approached. INTERVENTIONS Prior to surgery, participants were randomised to receive either 2g cephazolin or placebo (10ml normal saline) administered by the anaesthetist. Participants and other research staff were blinded to group allocation. MEASUREMENTS AND MAIN RESULTS The primary outcome was study feasibility measured by recruitment rates, compliance rates of drug administration, compliance rates of delivery, maintenance of double blinding and follow-up rates. Secondary outcomes included rate of postoperative infections, length of hospitalisation, re-admission to hospital, unscheduled presentations to healthcare facilities and antibiotic-related reactions. Between February 2019 and March 2021, 170 patients were approached with 117 (68.8%) participants recruited and randomised. The study had a high compliance rate of trial drug delivery (95.7%) and a high follow-up rate (99.1%). CONCLUSION This pilot study has demonstrated feasibility of a large-scale study with a recruitment rate of 68% of patients approached and excellent trial drug delivery and follow-up rates. As anticipated, it is underpowered for identifying clinically significant findings for postoperative infection rates. A large-scale study is appropriate and essential to determine the health-related risks of antibiotic prophylaxis with an emphasis on antimicrobial stewardship. The sample size for a large-scale study is 1678 participants based on infection rates in this pilot study.
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Affiliation(s)
- Claire Yinn Lim
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anaïs Alonso
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Yi Ying Koh
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Stephanie Roydhouse
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Archana Rao
- Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Louise Causer
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.
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Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review. Antibiotics (Basel) 2022; 11:antibiotics11020194. [PMID: 35203797 PMCID: PMC8868388 DOI: 10.3390/antibiotics11020194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/01/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Surgical site infections (SSIs) are among the most important determinants of morbidity after HBP surgery. Their frequency after HPB surgery is variable, from 1–2% after elective cholecystectomy to 25% after PD. Methods: A systematic review was performed to assess the role of antimicrobial prophylaxis (AP) in HPB elective surgery. Articles published between 2015 and 2021 were obtained; those before 2015 were not included because they antedate the WHO guidelines on SSI prevention. We conducted three different research methods for liver resection, elective cholecystectomy and pancreatic and biliary surgery regarding patients requiring preoperative biliary drainage. Results: Hepatic surgery, improvement in surgical technique and perioperative management lead to a very low SSI. One preoperative 2 g cefazolin dose may be adequate for surgical prophylaxis. From preoperative biliary drainage, we can derive that patients’ homeostasis rather than AP plays a paramount role in reducing postoperative morbidity. The time from biliary drainage could be an essential element in decision making for surgical prophylaxis. In the case of low-risk cholecystectomy, it is not easy to draw definitive conclusions about the effect of AP. Data from the literature are inconsistent, and some risk factors cannot be predicted before surgery. Conclusion: in our opinion, a strict preoperative cefazolin dose strategy can be reasonable in HBP surgery until a large-scale, multicentric RCT brings definitive conclusions.
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Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis. Surg Endosc 2021; 35:6397-6412. [PMID: 34370122 DOI: 10.1007/s00464-021-08658-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whether perioperative administration is required in elective laparoscopic cholecystectomy (LC) in patients with low risk of infection remains controversial. OBJECTIVE To investigate whether perioperative use of prophylactic antibiotics during elective LC can reduce the incidence of postoperative infection using a meta-analysis. METHODS Pubmed, Cochrane Library, Embase, and reference lists were searched up to October 26, 2020, for randomized controlled trials (RCTs) of the perioperative use of antibiotics during LC. A systematic review with meta-analysis, meta-regression, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) of the evidence was conducted. The Cochrane (RoB 2.0) tool was used to assess the risk of bias. RESULT A total of 14 RCTs were ultimately included in the meta-analysis, involving a total of 4360 patients. The incidence of surgical site infections, distant infections, and overall infections was investigated and the relationship with the perioperative use of prophylactic antibiotics during LC analyzed. The results indicated that in low-risk patients undergoing elective LC, prophylactic antibiotics reduce the incidence of surgical site infections (RR 0.66; 95% CI 0.45-0.98), with a moderate GRADE of evidence, distant infections (RR 0.34; 95% CI 0.16-0.73), with a low GRADE of evidence and overall infections (RR 0.57; 95% CI 0.40-0.80), with a moderate GRADE of evidence. CONCLUSIONS The present meta-analysis demonstrates that the perioperative use of antibiotics in LC is effective in low-risk patients, possibly reducing the incidence of surgical site infections, distant infections, and overall infections. However, in view of the limitations of the study, it is recommended that studies with a more rigorous design (for downgraded factors) and larger sample size should be conducted in the future so that the conclusions above can be further verified through key result indicators.
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The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2020; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
Background The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. Methods We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. Results There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. Conclusions The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients. Electronic supplementary material The online version of this article (10.1007/s00595-020-02181-6) contains supplementary material, which is available to authorized users.
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Dunn JC, Means KR, Desale S, Giladi AM. Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence. Hand (N Y) 2020; 15:534-541. [PMID: 30463441 PMCID: PMC7370387 DOI: 10.1177/1558944718812161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: There are no clearly defined guidelines from hand surgical societies regarding preoperative antibiotic prophylaxis. Many hand surgeons continue to routinely use preoperative prophylaxis with limited supporting evidence. This study aimed to determine for which scenarios surgeons give antibiotics, the reasons for administration, and whether these decisions are evidence-based. Methods: An anonymous 25-question survey was e-mailed to the 921-member American Society for Surgery of the Hand listserv. We collected demographic information; participants were asked whether they would administer antibiotics in a number of surgical scenarios and for what reasons. Respondents were broken into 3 groups based on when they said they would administer antibiotics: Group 1 (40 respondents) would give antibiotics in the case of short cases, healthy patients, without hardware; group 2 (9 respondents) would not give antibiotics in any scenario; and group 3 (129 respondents) would give antibiotics situationally. The Fisher exact test compared demographic variables, frequency of use, and indications of antibiotic prophylaxis. Results: Of the 921 recipients, 178 (19%) responded. Demographic variables did not correlate with the antibiotic use group. Operative case time >60 minutes, medical comorbidity, and pinning each increased antibiotic use. Group 1 respondents were more likely to admit that their practice was not evidence-based (74.4%) and that they gave antibiotics for medical-legal concern (75%). Twenty-two percent of respondents reported seeing a complication from routine prophylaxis, including Clostridium difficile infection. Conclusions: Antibiotics are still given unnecessarily before hand surgery, most often for medical-legal concern. Clear guidelines for preoperative antibiotic use may help reduce excessive and potentially inappropriate treatment and provide medical-legal support.
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Affiliation(s)
- John C. Dunn
- Walter Reed National Military Medical Center, Bethesda, MD, USA,The Curtis National Hand Center, Baltimore, MD, USA
| | | | | | - Aviram M. Giladi
- The Curtis National Hand Center, Baltimore, MD, USA,Aviram M. Giladi, c/o Anne Mattson, The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD 21218, USA.
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La Regina D, Mongelli F, Cafarotti S, Saporito A, Ceppi M, Di Giuseppe M, Ferrario di Tor Vajana A. Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis. BMC Surg 2018; 18:102. [PMID: 30453917 PMCID: PMC6245513 DOI: 10.1186/s12893-018-0442-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/08/2018] [Indexed: 01/29/2023] Open
Abstract
Background Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections. Methods Inclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were (“gallbladder”AND(“speciment”OR“extraction”OR“extract”))OR(“gallbladder”OR“cholecystectomy”)AND(“bag”OR“retrieval|”OR|“endobag”OR“endocatch”). Results The comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41–1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern. Conclusions The results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed. Electronic supplementary material The online version of this article (10.1186/s12893-018-0442-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
| | - Stefano Cafarotti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anaesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcello Ceppi
- Unit of Clinical Epidemiology, IRCCS - Ospedale San Martino, Genoa, Italy
| | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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10
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Alexander HC, Bartlett AS, Wells CI, Hannam JA, Moore MR, Poole GH, Merry AF. Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB (Oxford) 2018; 20:786-794. [PMID: 29650299 DOI: 10.1016/j.hpb.2018.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Consistent measurement and reporting of outcomes, including adequately defined complications, is important for the evaluation of surgical care and the appraisal of new surgical techniques. The range of complications reported after LC has not been evaluated. This study aimed to identify the range of complications currently reported for laparoscopic cholecystectomy (LC), and the adequacy of their definitions. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for prospective studies reporting clinical outcomes of LC, between 2013 and 2016. RESULTS In total 233 studies were included, reporting 967 complications, of which 204 (21%) were defined. One hundred and twenty-two studies (52%) did not provide definitions for any of the complications reported. Conversion to open cholecystectomy was the most commonly reported complication, reported in 135 (58%) studies, followed by bile leak in 89 (38%) and bile duct injury in 75 (32%). Mortality was reported in 89 studies (38%). CONCLUSION Considerable variation was identified between studies in the choice of measures used to evaluate the complications of LC, and in their definitions. A standardised set of core outcomes of LC should be developed for use in clinical trials and in evaluating the performance of surgical units.
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Affiliation(s)
- Harry C Alexander
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adam S Bartlett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jacqueline A Hannam
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew R Moore
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Garth H Poole
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Middlemore Hospital, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland, New Zealand.
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11
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Kim SH, Yu HC, Yang JD, Ahn SW, Hwang HP. Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis. Ann Hepatobiliary Pancreat Surg 2018; 22:231-247. [PMID: 30215045 PMCID: PMC6125276 DOI: 10.14701/ahbps.2018.22.3.231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/29/2018] [Accepted: 07/31/2018] [Indexed: 01/11/2023] Open
Abstract
Backgrounds/Aims The role of prophylactic antibiotics for laparoscopic cholecystectomy in low-risk patients is still unclear. This study aimed to verify the conclusion of previous meta-analyses concerning the effectiveness of antibiotic prophylaxis for elective laparoscopic cholecystectomy in low-risk patients. Methods Comprehensive literature searches were performed on electric databases and manual searches. Randomized controlled trials (RCTs), prospective studies, and retrospective studies comparing antibiotic prophylaxis to placebo or no antibiotics in low-risk elective laparoscopic cholecystectomy were included. Results This study included 28 RCTs, three prospective studies, and three retrospective studies. In RCTs, prophylactic antibiotics did not prevent deep surgical site infections (SSI) (RR 1.10, 95% confidence interval [CI] [0.45–2.69], p=0.84) but reduced SSI (RR 0.70, 95% CI [0.53–0.94], p=0.02), and superficial SSI (RR 0.58, 95% CI [0.42–0.82], p=0.01). Prospective studies showed prophylactic antibiotics did not reduce superficial SSI (RR 0.35, 95% CI [0.01–8.40], p=0.52) but reduced SSI (RR 0.12, 95% CI [0.04–0.35], p=0.0001). In retrospective studies, antibiotic prophylaxis did not reduce SSI (RR 1.59, 95% CI [0.30–8.32], p=0.58). The pooled data (12121 patients) including RCTs and prospective and retrospective studies showed that prophylactic antibiotics were not effective in preventing deep SSI (RR 1.01 95% CI [0.46–2.21], p=0.98) but effective in reducing SSI (RR 0.67, 95% CI [0.51–0.88], p=0.003) and superficial SSI (RR 0.61, 95% CI [0.45–0.83], p=0.002). Conclusions The use of prophylactic antibiotics is effective for reducing the incidence of SSI and superficial SSI but is not effective for preventing deep SSI in low-risk patients who underwent elective laparoscopic cholecystectomy.
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Affiliation(s)
- Sang Hoon Kim
- Department of Surgery, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk University Hospital, and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk University Hospital, and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Korea
| | - Jae Do Yang
- Department of Surgery, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk University Hospital, and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Korea
| | - Sung Woo Ahn
- Department of Surgery, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk University Hospital, and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Korea
| | - Hong Pil Hwang
- Department of Surgery, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk University Hospital, and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Korea
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Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis. J Gastrointest Surg 2018; 22:1193-1203. [PMID: 29556974 DOI: 10.1007/s11605-018-3739-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/05/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the effectiveness and harms of using antibiotic prophylaxis (ABP) versus placebo/no intervention in patients undergoing elective laparoscopic cholecystectomy (eLCC) to prevent surgical site infection (SSI). METHODS We searched MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to October 2017. We included clinical trials which involved adults at low risk undergoing eLCC and compared ABP versus placebo/no intervention. The primary outcome was SSI and secondary outcomes were other infections and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about risk difference (RD) with a 95% confidence interval (CI). Heterogeneity was evaluated using the I2 test. We produced network diagrams to show the amount of evidence available for each outcome and the most frequent comparison. RESULTS We included 18 studies in qualitative and quantitative analysis. The antibiotics most commonly studied were cefazolin and cefuroxime. We found high risk of detection bias in one study and attrition bias in another. Unclear risks of selection, performance, and detection bias were frequent. For SSI, we found no heterogeneity I2 = 0% and no inconsistency p = 0.9780. No significant differences were found when compared ABP versus placebo/no intervention. Cefazolin had a RD of - 0.00 (95% CI - 0.01 to 0.01). We found no differences in regular meta-analysis, with a RD of - 0.00 (95% CI - 0.01 to 0.01) as well as for intra-abdominal and distant infections. Adverse effects were only assessed in one study, without any case reported. CONCLUSIONS This systematic review demonstrated no differences between ABP versus placebo/no intervention when using to prevent SSI and intra-abdominal and distant infections in patients at low risk undergoing eLCC.
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13
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Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HM, Yeh DD, Fagenholz PJ, de Moya MA, King DR, Velmahos GC. Bile Spillage as a Risk Factor for Surgical Site Infection after Laparoscopic Cholecystectomy: A Prospective Study of 1,001 Patients. J Am Coll Surg 2018; 226:1030-1035. [DOI: 10.1016/j.jamcollsurg.2017.11.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 10/17/2022]
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Sajid MS, Bovis J, Rehman S, Singh KK. Prophylactic antibiotics at the time of elective cholecystectomy are effective in reducing the post-operative infective complications: a systematic review and meta-analysis. Transl Gastroenterol Hepatol 2018; 3:22. [PMID: 29780900 DOI: 10.21037/tgh.2018.04.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 11/06/2022] Open
Abstract
Background The objective of this article is to evaluate the role of prophylactic antibiotics in preventing the infective complications in patients undergoing elective laparoscopic cholecystectomy (ELC). Methods A systematic review of the literature on the published randomized, controlled reporting the role of prophylactic antibiotics in preventing the infective complications in patients undergoing ELC was undertaken using the principles of meta-analysis. Results Twenty-five RCTs on 6,138 patients evaluating the infective complications in patients undergoing ELC were systematically analysed. There were 3,099 patients in antibiotics group and 3,039 patients in no-antibiotics group. The risk of surgical site infection (SSI) [odds ratio (OR), 0.75 (95% CI, 0.52-1.07), P=0.11], distant infection [OR, 0.66 (95% CI, 0.21-2.14), P=0.49] and residual abscess [OR, 0.93 (95% CI, 0.23-3.81), P=0.92] was lower in the antibiotics group but statistical significance was not reached. However, the risk of overall all type of infective complications was statistically lower [OR, 0.69 (95% CI, 0.50-0.95), P=0.02] in the antibiotics group. Subsequently, this was reflected into the reduced length of hospitalization [standardized mean difference (SMD), -0.32 (95% CI, -0.54--0.10), P=0.004] in the antibiotics group. Conclusions Use of prophylactic antibiotics at the time of induction in patients undergoing ELC has clinically proven advantage of reducing the post-operative infective complications.
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Affiliation(s)
- Muhammad S Sajid
- Department of Gastrointestinal Surgery, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK
| | - Joanna Bovis
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - Saad Rehman
- Department of Gastrointestinal Surgery, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK
| | - Krishna K Singh
- Department of Gastrointestinal Surgery, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK
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Smith JP, Samra NS, Ballard DH, Moss JB, Griffen FD. Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy. Am Surg 2018. [DOI: 10.1177/000313481808400434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Surgical site infections with elective laparoscopic cholecystectomy are less frequent and less severe, leading some to suggest that prophylactic antibiotics (PA) are no longer indicated. We compared the incidence of surgical site infections before and after an institutional practice change of withholding PA for elective laparoscopic cholecystectomy. Between May 7, 2013, and March 11, 2015, no PA were given to patients selected for elective cholecystectomy by two surgeons at a single center. The only patients excluded were those who received antibiotics before surgery for any reason. All others, including those at high risk for infection, were included. The incidence and severity of infections were compared with historical controls treated with prophylaxis by the same two surgeons from November 6, 2011, to January 13, 2013. There were 268 patients in the study group and 119 patients in the control group. Infection occurred in 3.0 per cent in the study group compared with 0.9 per cent in the controls ( P = 0.29). All infections were mild except one. Based on these data, the routine use of PA for elective laparoscopic cholecystectomy is not supported.
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Affiliation(s)
- J. Patrick Smith
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Navdeep S. Samra
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - David H. Ballard
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Jonathan B. Moss
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Forrest D. Griffen
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
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Matsui Y, Satoi S, Hirooka S, Kosaka H, Kawaura T, Kitawaki T. Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews. BMJ Open 2018; 8:e016666. [PMID: 29549197 PMCID: PMC5857705 DOI: 10.1136/bmjopen-2017-016666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/15/2017] [Accepted: 02/01/2018] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Many researchers have addressed overdosage and inappropriate use of antibiotics. Many meta-analyses have investigated antibiotic prophylaxis for low-risk laparoscopic cholecystectomy with the aim of reducing unnecessary antibiotic use. Most of these meta-analyses have concluded that prophylactic antibiotics are not required for low-risk laparoscopic cholecystectomies. This study aimed to assess the validity of this conclusion by systematically reviewing these meta-analyses. METHODS A systematic review was undertaken. Searches were limited to meta-analyses and systematic reviews. PubMed and Cochrane Library electronic databases were searched from inception until March 2016 using the following keyword combinations: 'antibiotic prophylaxis', 'laparoscopic cholecystectomy' and 'systematic review or meta-analysis'. Two independent reviewers selected meta-analyses or systematic reviews evaluating prophylactic antibiotics for laparoscopic cholecystectomy. All of the randomised controlled trials (RCTs) analysed in these meta-analyses were also reviewed. RESULTS Seven meta-analyses regarding prophylactic antibiotics for low-risk laparoscopic cholecystectomy that had examined a total of 28 RCTs were included. Review of these meta-analyses revealed 48 miscounts of the number of outcomes. Six RCTs were inappropriate for the meta-analyses; one targeted patients with acute cholecystitis, another measured inappropriate outcomes, the original source of a third was not found and the study protocols of the remaining three were not appropriate for the meta-analyses. After correcting the above miscounts and excluding the six inappropriate RCTs, pooled risk ratios (RRs) were recalculated. These showed that, contrary to what had previously been concluded, antibiotics significantly reduced the risk of postoperative infections. The rates of surgical site, distant and overall infections were all significantly reduced by antibiotic administration (RR (95% CI); 0.71 (0.51 to 0.99), 0.37 (0.19 to 0.73), 0.50 (0.34 to 0.75), respectively). CONCLUSIONS Prophylactic antibiotics reduce the incidence of postoperative infections after elective laparoscopic cholecystectomy.
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Affiliation(s)
- Yoichi Matsui
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Satoshi Hirooka
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Hisashi Kosaka
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Takayuki Kawaura
- Department of Mathematics, Kansai Medical University, Hirakata, Japan
| | - Tomoki Kitawaki
- Department of Mathematics, Kansai Medical University, Hirakata, Japan
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17
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Cohen ME, Salmasian H, Li J, Liu J, Zachariah P, Wright JD, Freedberg DE. Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections. J Am Coll Surg 2017; 225:631-638.e3. [PMID: 29030239 DOI: 10.1016/j.jamcollsurg.2017.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antibiotic-resistant infections have high rates of morbidity and mortality, and exposure to antibiotics is the crucial risk factor for development of antibiotic resistance. If surgical antibiotic prophylaxis (SAP) increases risk for antibiotic-resistant infections, prophylaxis may cause net harm, even if it decreases overall infection rates. STUDY DESIGN This retrospective cohort study included adults who underwent elective surgical procedures and developed infections within 30 postoperative days. Procedures from multiple disciplines were included if SAP was considered discretionary by current guidelines. Postoperative antibiotic-resistant infections were defined as positive culture results from any site within 30 postoperative days, showing intermediate or nonsusceptibility across 1 or more antibiotic classes. Surgical antibiotic prophylaxis included use of antibiotics within any class and at any dose from 1 hour before first incision until the end of the operation. RESULTS Among 689 adults with postoperative infections, 338 (49%) had postoperative resistant infections. Use of SAP was not associated with postoperative antibiotic-resistant infections (odds ratio [OR] 0.99; 95% CI 0.67 to 1.46). This result remained robust when the SAP definition was extended to antibiotics given within 4 hours before first incision (OR 0.94; 95% CI 0.63 to 1.40) and when the follow-up window was narrowed to 14 days (OR 0.82; 95% CI 0.50 to 1.34). Previous antibiotic-resistant infections were associated with risk for postoperative antibiotic-resistant infections (OR 1.81; 95% CI 1.16 to 2.83). CONCLUSIONS Use of SAP was not associated with risk for postoperative antibiotic-resistant infections in a large cohort of patients with postoperative infections. This provides important reassurance regarding use of surgical antibiotic prophylaxis.
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Affiliation(s)
- Margot E Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Hojjat Salmasian
- Biomedical Informatics, New York-Presbyterian Hospital, New York, NY
| | - Jianhua Li
- Biomedical Informatics, New York-Presbyterian Hospital, New York, NY
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY
| | - Philip Zachariah
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, NY.
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18
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Williams K, Baumann L, Abdullah F, St Peter SD, Oyetunji TA. Variation in prophylactic antibiotic use for laparoscopic cholecystectomy: need for better stewardship in pediatric surgery. J Pediatr Surg 2017; 53:S0022-3468(17)30634-6. [PMID: 29106917 DOI: 10.1016/j.jpedsurg.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/05/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The role of prophylactic antibiotics for elective laparoscopic cholecystectomy has been questioned over the last decade. Although gradually being discontinued in the adult population, the practice among pediatric surgeons remains unknown. Our aim was to investigate the use of perioperative antibiotics in children undergoing elective laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis and biliary dyskinesia. METHODS We retrospectively reviewed the Pediatric Health Information System (PHIS) database for 2015 and selected all patients 18years old or younger who underwent LC for cholelithiasis (without cholecystitis) or biliary dyskinesia. Demographic and hospital data were extracted as well as antibiotics administered and surgical complications. RESULTS A total of 1112 patients from 44 hospitals were identified with a median age of 15years (IQR 13-16years). Eight out of every 10 hospitals routinely give prophylactic antibiotics in more than 50% of patients. In 37 hospitals that performed more than 5 LC per year, 19 to 100% of patients were given antibiotics. No surgical complications were identified in those who did not get antibiotics. CONCLUSION There is significant inter-hospital variation in prophylactic antibiotic administration for elective LC in children. Perioperative antibiotic administration should be tracked as a quality metric in the current push for better stewardship. LEVEL OF EVIDENCE III. TYPE OF STUDY Retrospective.
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Affiliation(s)
- Kibileri Williams
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611; Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC, 20060
| | - Lauren Baumann
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Fizan Abdullah
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Shawn D St Peter
- Children's Mercy Hospital Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108
| | - Tolulope A Oyetunji
- Children's Mercy Hospital Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108.
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Kim HJ, Kang SH, Roh YH, Kim MC, Kim KW. Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk? Ann Surg Treat Res 2017; 93:76-81. [PMID: 28835883 PMCID: PMC5566750 DOI: 10.4174/astr.2017.93.2.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The average rate of surgical site infections (SSIs) for laparoscopic cholecystectomy (LC) has been reported in the literature to be between 0.4% and 6.3%. Also, these recent reviews have concluded that a prophylactic antibiotics for elective LCs in low-risk patients is not useful, but there were no results in high-risk patients. METHODS The aim of this study was to investigate the role of a single dose of first-generation cephalosporin as a prophylactic antibiotic for patients undergoing elective LC, regardless of patient risk. This randomized clinical trial was conducted from October 2013 to December 2014 by single surgeon at our hospital. Patients were randomized into two groups by following method. Odd-numbered patients (group A) received 1-g cefazolin intravenously within 30 minutes before incision, whereas even-numbered patients (group B) received normal saline intravenously instead of prophylactic antibiotics, with the aim of including 100 patients in each group. SSIs were recorded and compared between the groups. RESULTS There were no differences in preoperative demographics and postoperative findings between the groups. There were no superficial and deep SSIs in either group, 9 cases of superficial seromas developed (4.5%) in the cohort: 4 in group A (4%) and 5 in group B (5%). There were no significant associations between SSIs and the use of prophylactic antibiotics in either group. Additionally, the high-risk group did not show a significantly increased rate of SSIs. CONCLUSION Based on our study, prophylactic antibiotics are not necessary in elective LC, regardless of patient risk.
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Affiliation(s)
- Hyung Jin Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Sung Hwa Kang
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Young Hoon Roh
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Min Chan Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
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Sarkut P, Kilicturgay S, Aktas H, Ozen Y, Kaya E. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt) 2017; 18:603-609. [PMID: 28375803 DOI: 10.1089/sur.2016.265] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gallbladder stones. As infections are rare in uncomplicated LC, it is widely accepted that prophylactic antibiotics need not be administered, and guidelines do not support routine antibiotic prophylaxis during elective LC. However, routine antibiotic prophylaxis for elective LC is still popular in many clinical settings. We investigated this situation in our department. METHOD This randomized double-blind controlled study included 570 patients who underwent LC between March 2007 and February 2010. The exclusion criteria were antibiotic intake before surgery, steroid treatment, and the presence of pancreatitis, cholangitis, obstructive jaundice, cephalosporin allergy, or pregnancy. The patients were randomized into three groups. Group 1 (n = 193) received physiologic saline as placebo, Group 2 (n = 191) received a first-generation cephalosporin (cefazolin; 1 g), and Group 3 (n = 186) received a second-generation cephalosporin (cefuroksim aksetil; 750 mg). Bile and epigastric and umbilical port tissue samples were harvested for culture. All patients were observed until the end of the fourth week after surgery. Patient age, sex, weight, American Society of Anesthesiologists (ASA) score, diabetes mellitus, smoking history, history of biliary colic in the past month, length of the hospital stay before the operation, operational findings (acute or chronic cholecystitis), operation duration, use of drainage, type of prophylaxis administered if any, culture results, surgical site infection (SSI) development, and time to SSI development along with associated treatments were evaluated. RESULTS There was no statistically significant difference between the groups with respect to any of the demographic and clinical features analyzed in this study. The SSI rate was 1.2% in total, and in Groups 1, 2, and 3, it was 1.5%, 1.04%, and 1.07%, respectively. There was no statistical difference regarding SSI among the groups (p = 1.00). Superficial SSI was observed in all groups, and in all patients, the site of infection was the entrance to the epigastric port through which the gallbladder had been removed. CONCLUSIONS Surgical site infection is rare after LC, and antibiotic prophylaxis does not appear to affect the outcome significantly. Moreover, factors such as positive bile cultures, history of biliary attack, ASA score, diabetes, obesity, and smoking do not have any effect on SSI development. Thus, we conclude that antibiotic prophylaxis is not needed for elective LC.
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Affiliation(s)
- Pinar Sarkut
- 1 Department of General Surgery, Uludag University , Bursa, Turkey
| | - Sadik Kilicturgay
- 2 Department of General Surgery, Medical Park International Hospital , Bursa, Turkey
| | - Hikmet Aktas
- 3 Department of General Surgery, Acibadem International Hospital , Bursa, Turkey
| | - Yilmaz Ozen
- 1 Department of General Surgery, Uludag University , Bursa, Turkey
| | - Ekrem Kaya
- 1 Department of General Surgery, Uludag University , Bursa, Turkey
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Passos MAT, Portari-Filho PE. ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:170-172. [PMID: 27759780 PMCID: PMC5074668 DOI: 10.1590/0102-6720201600030010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/12/2016] [Indexed: 12/16/2022]
Abstract
Background: Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis Aim: Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Method: Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. Results: There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. Conclusion: The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection.
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Liang B, Dai M, Zou Z. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: A systematic review and meta-analysis. J Gastroenterol Hepatol 2016; 31:921-8. [PMID: 26637110 DOI: 10.1111/jgh.13246] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/16/2015] [Accepted: 11/21/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM Owing to persistent controversy regarding the use of routine antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy and the availability of several new randomized controlled trials (RCTs), we conducted an up-to-date meta-analysis to provide the best current evidence. The aim of the article is to evaluate the safety and efficacy of routine antibiotic prophylaxis in low-risk patients undergoing elective laparoscopic cholecystectomy. METHODS We conducted a comprehensive literature review of the PubMed, Embase, and Cochrane Library databases for RCTs that compared antibiotic prophylaxis versus placebo or no antibiotics in low-risk patients undergoing elective laparoscopic cholecystectomy. RESULTS The meta-analysis included 21 RCTs (5207 patients). Antibiotic prophylaxis reduced the incidence of surgical site infections (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82, P = 0.001) and global infections (RR 0.55, 95% CI 0.38 to 0.79, P = 0.001) during hospitalization or after discharge, and postoperative length of hospital stay (weighted mean difference -0.16, 95% CI -0.28 to -0.04, P = 0.008). No adverse events were reported. Subgroup analyses demonstrated that two doses of antibiotic and 3-10 doses of antibiotic significantly reduced the incidence of surgical site infections compared with placebo or no antibiotics (two doses: RR 0.16, 95% CI 0.06-0.47; 3-10 doses: RR 0.46, 95% CI 0.27-0.80), while a single dose of antibiotic administration did not. CONCLUSION Antibiotic prophylaxis is safe and effective in reducing surgical site infections and global infections during hospitalization or after discharge, and postoperative length of hospital stay in low-risk patients undergoing elective laparoscopic cholecystectomy.
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Affiliation(s)
- Bo Liang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Min Dai
- Department of General Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital, Nanchang, Jiangxi, China
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Wu S, Lv C, Tian Y, Fan Y, Yu H, Kong J, Li Y, Yu X, Yao D, Chen Y, Han J. Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center. Surg Endosc 2015; 30:3375-85. [DOI: 10.1007/s00464-015-4618-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/05/2015] [Indexed: 02/08/2023]
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Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg 2015; 103:27-34; discussion 34. [DOI: 10.1002/bjs.9904] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/21/2015] [Accepted: 06/23/2015] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The effectiveness of perioperative antibiotics in reducing surgical-site infection (SSI) and overall nosocomial infections in patients undergoing laparoscopic cholecystectomy for biliary colic and low- and moderate-risk cholecystitis (Tokyo classification) is unclear. A systematic review and meta-analysis was performed to assess this.
Methods
Searches were conducted of the MEDLINE, Embase and Cochrane databases. Only randomized clinical trials (RCTs) were included. The analysis was performed using the random-effects method, and the risk ratio (RR) with 95 per cent c.i. was employed.
Results
Nineteen RCTs, published between 1997 and 2015, with a total of 5259 participants, of whom 2709 (51·5 per cent) were treated with antibiotics, were included. SSI and overall nosocomial infections were detected in 2·4 and 4·2 per cent respectively of patients given perioperative antibiotics, and in 3·2 and 7·2 per cent of those who received no antibiotics. Antibiotics did not significantly reduce the risk of SSI (RR 0·81, 95 per cent c.i. 0·58 to 1·13; P = 0·21) or overall nosocomial infections (RR 0·64, 0·36 to 1·14; P = 0·13). There was no significant between-study heterogeneity for SSI, but significant between-study heterogeneity in the eight studies that reported nosocomial infections. Analysis of studies considered to be high quality, grouped according to the timing of antibiotics (preoperative only or perioperative) and reporting intention-to-treat analyses, again failed to show a significant reduction in SSI.
Conclusion
Antibiotics should not be administered before laparoscopic cholecystectomy in patients with biliary colic and/or low- and moderate-risk cholecystitis.
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Affiliation(s)
- S Pasquali
- Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham, UK
| | - M Boal
- Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - D Alderson
- Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - R S Vohra
- Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
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