Dylan M Russell, MD. Tripler Army Medical Center
Introduction: The aim of this meta-analysis was to assess the beneficial or harmful effects of antibiotic prophylaxis in elective laparoscopic cholecystectomies for non-acute gallbladder disease. This meta-analysis strictly involved randomized controlled trials (RCTs) that have been published since the publication of the relevant Cochrane Review (Sanabria et al., 2010).
Methods: Pubmed was searched for RCTs regarding antibiotic prophylaxis in laparoscopic cholecystectomies since 2010. Only RCTs that met the following inclusion criteria were eligble for inclusion: 1) two standard deviations below the reported mean age was greater than 17 years old; 2) only elective laparoscopic cholecystectomies; 3) preoperative clinical diagnosis of cholelithiasis without acute cholecystitis or other benign non-acute inflammatory disease of the gallbladder. 4) patients did not have jaundice; 5) published in 2010 or later and not included in the Cochrane Review. Outcome measures were surgical site infections (SSIs) as diagnosed by CDC criteria and non-SSI infections. All outcome measures were confined to within hospitalization or 30 days after discharge. The outcomes were reported as odds ratios with 95% confidence intervals. Study heterogeneity was also reported as an I2 value.
Results: Five of 42 eligible studies met the inclusion criteria with 1,725 included patients. No significant difference between antibiotic prophylaxis and no prophylaxis in the proportion of SSIs (18 of 837 [2.15%], 20 of 888 [2.25%]; OR 0.95 [95% CI 0.5 – 1.8]). Heterogeneity was not statiscally significant. Four of five studies reported non-SSI rates; all four studies reported an incidence of 0%.
Conclusion: Antibiotic prophylaxis is likely not needed in patients undergoing elective laparoscopic cholecystectomy for non-acute conditions. The evidence suggests it is safe to forego prophylaxis in low-risk patients but there is insufficient evidence to support not using antibiotic prophylaxis in all patients. Larger randomised clinical trials with intention-to-treat analyses and the inclusion of higher-risk patients should be undertaken in the future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88105
Program Number: MSSP06
Presentation Session: Military iPoster (Non CME)
Presentation Type: MSSPoster