Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: A randomized clinical trial

A Comparative Analysis of Prophylactic Antibiotic Administration in Emergency Surgery Versus Elective Surgery: A Comprehensive Review

Surgical site infections (SSIs) contribute to increased patient morbidity, prolonged hospital stays, and substantial healthcare costs. Prophylactic antibiotics play a pivotal role in mitigating the risk of SSIs, with their administration being a standard practice before both emergency and elective surgeries. This paper provides a comprehensive review and comparative analysis of the benefits of prophylactic antibiotic administration in emergency surgery versus elective surgery. Through a systematic literature review and analysis of relevant studies identified through PubMed searches, this paper highlights the specific benefits of prophylactic antibiotics between emergency and elective surgeries. The findings underscore the importance of tailored antibiotic regimens and administration protocols to optimize patient care and promote successful surgical outcomes in diverse clinical settings. Further research is warranted to refine guidelines and enhance understanding of the relationship between prophylactic antibiotics and surgical outcomes across different surgical contexts.

Effect of accelerated rehabilitation nursing programmes on surgical site wound infection in patients undergoing laparoscopic cholecystectomy: A meta-analysis

This study aims to evaluate the effect of an accelerated rehabilitation nursing programme on the incidence of surgical site wound infections in patients undergoing laparoscopic cholecystectomy. Relevant studies regarding the use of an accelerated rehabilitation nursing programme in laparoscopic cholecystectomy were retrieved from databases, including PubMed, Web of Science, the Cochrane Library, EMBASE, CNKI and Wanfang Database. The search was conducted from the inception of each database until June 2023. Two independent researchers performed the literature screening, data collection and quality assessment of the included studies. Odds ratio (OR) and 95% confidence interval (CI) were used as the measures of effect. Statistical analysis was conducted using Stata 17.0, and a sensitivity analysis and publication bias evaluation were performed. A total of 21 studies involving 2480 patients (1179 in the intervention group and 1301 in the control group) were included. The meta-analysis revealed that the incidence of surgical site wound infections in the intervention group was significantly lower than in the control group (1.18% vs. 5.99%, OR: 0.322, 95% CI: 0.168-0.556, p < 0.001). Current evidence suggests that implementing accelerated rehabilitation nursing programmes for patients undergoing laparoscopic cholecystectomy has a clinically significant effect, leading to a substantial reduction in the incidence of surgical site wound infections. However, owing to the low quality of some of the included studies, further high-quality, multicentre, large-sample randomised controlled trials are required to validate the conclusions of this study.

The effect of antibiotic prophylaxis on the incidence of surgical site infection after laparoscopic appendectomy for chronic appendicitis

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.

Role of antibiotic prophylaxis on surgical site infection prevention in a low-risk population undergoing laparoscopic cholecystectomy: A randomized controlled study

Objective

Study design

Setting

Methods

Results

Conclusion

•

One of the postoperative complications following cholecystectomy is surgical site infections (SSIs).

•

This study aimed to determine the effectiveness of preoperative antibiotic prophylaxis in preventing SSIs.

•

We found that prophylactic antibiotics have no impact in preventing SSIs in low-risk individuals undergoing laparoscopic cholecystectomy.

Intraoperative bile spillage as a risk factor for surgical site infection: a propensity score-matched NSQIP analysis

BACKGROUND

Laparoscopic cholecystectomy is one of the most commonly performed operations in the USA. Surgical site infection complicates 1-2% of these operations and can be associated with significant morbidity. Bile spillage (bile spillage) occurs in many of these operations. The associated risk of surgical site infection (SSI) is an ongoing area of research.

METHODS

NSQIP registries between 2005 and 2018 were queried using Current Procedural Terminology codes 47,562 and 47,563 to identify patients undergoing elective laparoscopic cholecystectomy. Patients were considered to have bile spillage if the wound classification was annotated 3 or 4. Acute cholecystitis was excluded by ICD code. Patients were propensity scored for bile spillage and matched for preoperative risk factors. The rates of surgical site infections, morbidity, and mortality and length of stay were analyzed.

RESULTS

47,919 (31,946 with no spillage and 15,973 with spillage) patients were matched and included in the analysis. After matching, no significant difference was found in superficial or deep SSI regardless of bile spillage. An absolute increase in organ-space SSI of 0.32% was detected. The group with bile spillage had small increases in both minor (1.41% vs. 2.12%) and major (0.67% vs. 1.01%) complications. There was no difference in mortality.

CONCLUSIONS

This database analysis demonstrates no clinically relevant difference in surgical site infection rates after intraoperative bile spillage.

Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis

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.

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

BACKGROUND

Laparoscopic cholecystectomy is a safe ambulatory procedure in appropriately selected patients; however, day case rates remain low. The objective of this systematic review and meta-analysis was to identify interventions which are effective in reducing the length of stay (LOS) or improving the day case rate for elective laparoscopic cholecystectomy.

METHODS

Comparative English-language studies describing perioperative interventions applicable to elective laparoscopic cholecystectomy in adult patients and their impact on LOS or day case rate were included.

RESULTS

Quantitative data were available for meta-analysis from 80 studies of 10,615 patients. There were an additional 17 studies included for systematic review. The included studies evaluated 14 peri-operative interventions. Implementation of a formal day case care pathway was associated with a significantly shorter LOS (MD = 24.9 h, 95% CI, 18.7-31.2, p < 0.001) and an improved day case rate (OR = 3.5; 95% CI, 1.5-8.1, p = 0.005). Use of non-steroidal anti-inflammatories, dexamethasone and prophylactic antibiotics were associated with smaller reductions in LOS.

CONCLUSION

Care pathway implementation demonstrated a significant impact on LOS and day case rates. A limited effect was noted for smaller independent interventions. In order to achieve optimal day case targets, a greater understanding of the effective elements of a care pathway and local barriers to implementation is required.

The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018

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.

Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis

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.

Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomy: a Systematic Review and Network Meta-Analysis

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.

Prophylactic antibiotics at the time of elective cholecystectomy are effective in reducing the post-operative infective complications: a systematic review and meta-analysis

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.

Prophylactic Antibiotics for Elective Laparoscopic Cholecystectomy

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.

Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews

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.

Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study

Premise and Objective:

Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting.

Materials and Methods:

Two hundred and ten successive patients undergoing elective LC were randomised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia, (Group A = 112 cases) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively (Group B = 98 cases). Post-operative infectious complications between two groups were compared for variables such as age, sex, body mass index and bile/stone spillage.

Results:

There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, American Society of Anesthesiologists grade, duration of surgery and hospital stay. Intraoperative spillage of stones (9.8% [A]: 5.1% [B]) did not increase infectious complications even in the presence of positive bile culture (Group A, N = 7 vs. Group B, N = 3). An operative time of greater than 60 min was found to be associated with increased surgical site infection (P = 0. 0006).

Conclusion:

Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be abandoned as it contributes to adverse reactions, drug resistance and unnecessary financial burden.

Variation in prophylactic antibiotic use for laparoscopic cholecystectomy: need for better stewardship in pediatric surgery

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.

ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

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.

Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: A systematic review and meta-analysis

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.

Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy

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.