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Tracy BM, Paterson CW, Torres DM, Young K, Saxe JM, Kinstedt DP, Zielinski MD, Camazine M, Yeh DD, Gelbard RB. The effect of prolonged antibiotics on postoperative complications for common bile duct stones: A post hoc analysis of an EAST multicenter study. J Trauma Acute Care Surg 2021; 91:234-240. [PMID: 34144566 DOI: 10.1097/ta.0000000000003203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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 (CBD) stones is limited. We sought to examine the effect of antibiotic duration on infectious complications in patients with choledocholithiasis and/or gallstone pancreatitis. METHODS We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019. We excluded patients with cholangitis and/or cholecystitis. Patients were divided into groups based on duration of antibiotics: prophylactic (<24 hours) or prolonged (≥24 hours). We analyzed these two groups in the preoperative and postoperative periods. Outcomes included infectious complications, acute kidney injury (AKI), and hospital length of stay (LOS). RESULTS There were 755 patients in the cohort. Increasing age, CBD diameter, and a preoperative endoscopic retrograde cholangiopancreatography (odds ratio, 1.91; 95% confidence interval, 1.34-2.73; p < 0.001) significantly predicted prolonged preoperative antibiotic use. Increasing age, operative duration, and a postoperative endoscopic retrograde cholangiopancreatography (odds ratio, 4.8; 95% confidence interval, 1.85-13.65; p < 0.001) significantly predicted prolonged postoperative antibiotic use. Rates of infectious complications were similar between groups, but LOS was 2 days longer for patients receiving overall prolonged antibiotics (p < 0.0001). Patients with AKI received two more days of overall antibiotic therapy (p = 0.02) compared with those without AKI. CONCLUSION Rates of postoperative infectious complications were similar among patients treated with a prolonged or prophylactic course of antibiotics. Prolonged antibiotic use was associated with a longer LOS and AKI. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Brett M Tracy
- From the Department of Surgery (B.M.T.), The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Surgery (C.W.P.), Emory University School of Medicine; Division of Acute Care Surgery (C.W.P., R.B.G.), Grady Memorial Hospital, Atlanta, Georgia; Department of Surgery (D.M.T., K.Y.), Geisinger Medical Center, Danville, Pennsylvania; Department of Surgery (J.M.S., D.P.K.), Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Trauma, Critical Care, and General Surgery (M.D.Z., M.C.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (D.D.Y.), Jackson Memorial Hospital-University of Miami Health System, Miami, Florida; and Division of Acute Care Surgery (R.B.G.), University of Alabama at Birmingham, Birmingham, Alabama
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Young Kim E, Ho Hong T. Empirical antibiotics for acute cholecystitis-what generation of antibiotics is an appropriate choice? A prospective, randomized controlled study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:848-855. [PMID: 33644968 DOI: 10.1002/jhbp.926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND In cases of acute cholecystitis (AC), empirical antibiotics are used to prevent infectious morbidities following cholecystectomy. However, there are still no exact guidelines on which antibiotics to use. METHODS We enrolled 300 patients who had been admitted for cholecystectomy because of grade I or II AC. We randomly allocated them to one of two groups empirically: the first group was to be given first-generation cephalosporins (group I, 150 patients) and the second group was to be given second-generation cephalosporins (group II, 150 patients). We analyzed the clinical outcomes and the incidence of postoperative infectious morbidities. RESULTS The incidence rate of overall infectious morbidities (18 cases, 12% in group I; 17 cases, 11.3% in group II; P = .859) showed no difference between the two groups. The incidence rate of sepsis (only one case, 0.7% in group II, P = 1.000) or surgical site infection (nine cases, 6% in group I and eight cases, 5.3% in group II, P = 1.000) were also similar in both groups. CONCLUSIONS The empirical use of first-generation cephalosporins for mild-to-moderate AC without gallbladder perforation was not inferior to using second-generation cephalosporin for prophylaxis against postoperative infection. Our results could allow for a tailored treatment strategy of empirical antibiotics according to the severity of the cholecystitis.
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Affiliation(s)
- Eun Young Kim
- Department of Trauma and Surgical Critical Care, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Ho Hong
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhang H, Wang Y, Yang S, Zhang Y. Peri-Operative Antibiotic Prophylaxis Does Not Reduce Surgical Site Infection in Breast Cancer. Surg Infect (Larchmt) 2019; 21:268-274. [PMID: 31697199 DOI: 10.1089/sur.2019.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The reported rate of surgical site infection (SSI) in breast surgery is often higher than expected. Using antibiotic prophylaxis to reduce SSI is debatable because of the risk of developing bacteria resistance and the cost burden. In this study, we evaluated the effectiveness of antibiotic prophylaxis in breast surgery and the factors predisposing patients to SSI. Methods: A retrospective-prospective (ambispective) study was conducted in the Department of Breast Surgery, Qilu Hospital, P.R. China. The retrospective antibiotic-using group was composed of patients found to have breast cancer between January 2008 and October 2010. The prospective non-antibiotic-using group was composed of patients identified between November 2010 and November 2013. Pre-operative, peri-operative, and post-operative clinical data were analyzed. Results: The SSI rate of the non-prophylaxis and prophylaxis groups was 1.1% (11/1,022) and 1.2% (12/1,034), respectively. Neoadjuvant chemotherapy was related to SSI in the non-prophylaxis group (p = 0.026). Staphylococcus aureus was the predominant microorganism responsible for SSI, without obvious resistance to a widely used first-generation cephalosporin. Conclusions: Peri-operative antibiotic prophylaxis is of no significant value in preventing SSI in breast cancer surgery. Our results indicated that neoadjuvant chemotherapy might be a risk factor doe SSI, but further research is needed because of the sample size disparity between infected and uninfected groups.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, Qilu Hospital, Shandong University School of Medicine, Ji'nan, Shandong, P.R. China
| | - Yang Wang
- Department of Pediatrics, Qilu Hospital, Shandong University School of Medicine, Shandong, P.R. China
| | - Shuang Yang
- Department of General Surgery, Laiwu Maternal and Child Health Care Hospital, Laiwu, Shandong, P.R. China
| | - Yan Zhang
- Department of Nursing, Qilu Hospital, Shandong University School of Medicine, Shandong, P.R. China
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Guo T, Chen B, Rao F, Wu P, Liu P, Liu Z, Li Z. Identifying the superior antibiotic prophylaxis strategy for breast surgery: A network meta-analysis. Medicine (Baltimore) 2019; 98:e15405. [PMID: 31027139 PMCID: PMC6831324 DOI: 10.1097/md.0000000000015405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The clinical roles of different antibiotic prophylaxis strategies for breast surgery remains large unknowns. The aim of this study is to evaluate different antibiotic prophylaxis strategies based on a network meta-analysis. METHODS We initially retrieved literature from globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating the antibiotic prophylaxis strategies for breast surgery. Relative postoperative infection rates were quantitatively pooled and estimated based on the Bayesian theorem. Values of surface under the cumulative ranking curve (SUCRA) probabilities were calculated and ranked. Additional pairwise meta-analyses were performed to validate differences between the respective strategies at the statistical level for further explanations. RESULTS After a detailed review, a total of 14 RCTs containing 6 different strategies were included for the network meta-analysis. The results indicated that the application of antibiotics administered during pre- plus post- plus intraoperative periods possessed the highest possibility of having the best clinical effects (SUCRA, 0.40), followed by intraoperative administration alone (SUCRA, 0.35) and pre- plus intraoperative administrations (SUCRA, 0.20). Moreover, an additional pairwise meta-analysis determined that pre- and intraoperative-related strategies significantly reduced postoperative infections at a statistical level. CONCLUSION Based on the current evidence, we concluded that application of antibiotics administered during pre- plus post- plus intraoperative periods seemed to reveal superior benefits. However, the essential roles of pure intraoperative and postoperative application were still need to be further validated.
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Affiliation(s)
- Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Baiyang Chen
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Fengying Rao
- School of Nursing, Huanggang Polytechnic College, Huanggang, P.R. China
| | - Ping Wu
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Pengpeng Liu
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Zhisu Liu
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery, and Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan
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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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Jaafar G, Darkahi B, Lindhagen L, Persson G, Sandblom G. Disparities in the regional, hospital and individual levels of antibiotic use in gallstone surgery in Sweden. BMC Surg 2017; 17:128. [PMID: 29207972 PMCID: PMC5717817 DOI: 10.1186/s12893-017-0312-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial resistance may be promoted by divergent routines and lack of conformity in antibiotic treatment, especially regarding the practice of antibiotic prophylaxis. The aim of the present study was to assess differences in gallstone surgery regarding antibiotic use in Sweden. Methods The study was based on data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) 2005–2015. Funnel plots were used to test impact of grouping factors, including, hospital and surgeon and to identify units that deviated from the rest of the population. Results After adjusting for cofounders including age, gender, ASA classification, indication for surgery, operation time, gallbladder perforation and emergency status, there were 0/21 (0%) at the regional level, 18/76 (24%) at the hospital level and 128/1038 (12%) at the surgeon level outside the 99.9% confidence interval (CI). The estimated median odds ratios were 1.13 (95% CI 1.00–1.31) at the regional level, 1.93 (95% CI 1.70–2.19) at the hospital level and 2.38 (95% CI 2.26–2.50) at the surgeon level. Conclusion There are significant differences between hospitals and surgeons, but little or no differences between regions. These deviations confirm the lack of standardization in regards to prescription of antibiotic prophylaxis and the need more uniform routines regarding antibiotic usage. Randomized controlled trials and large population-based studies are necessary to assess assessing the effectiveness and safety of antibiotic prophylaxis in gallstone surgery.
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Affiliation(s)
- Gona Jaafar
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, -141 86, Stockholm, SE, Sweden.
| | - Bahman Darkahi
- Department of Surgery, Enköping Hospital, Kungsgatan 71, 74538, Enköping, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Centre, Dag Hammarskjölds väg 14B, 75237, Uppsala, Sweden
| | - Gunnar Persson
- Department of Surgery, Växjö Hospital, Strandvägen 8, 35185, Växjö, Sweden
| | - Gabriel Sandblom
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, -141 86, Stockholm, SE, Sweden
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Chauhan VS, Kariholu PL, Saha S, Singh H, Ray J. Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study. J Minim Access Surg 2017; 14:192-196. [PMID: 29067946 PMCID: PMC6001298 DOI: 10.4103/jmas.jmas_95_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Vikram Singh Chauhan
- Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - P L Kariholu
- Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Sabyasachi Saha
- Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Himanshu Singh
- Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Jasmine Ray
- Department of Surgery, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
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Vohra RS, Hodson J, Pasquali S, Griffiths EA. Effectiveness of Antibiotic Prophylaxis in Non-emergency Cholecystectomy Using Data from a Population-Based Cohort Study. World J Surg 2017; 41:2231-2239. [PMID: 28444464 PMCID: PMC5544819 DOI: 10.1007/s00268-017-4018-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is a variation in the administration of antibiotics prophylaxis to reduce the perceived risk of SSI in patients undergoing non-emergency cholecystectomy. The aim of this study was to determine the effectiveness of antibiotic prophylaxis following non-emergency cholecystectomy to prevent 30-day superficial surgical site infections (SSIs) using non-selected, nationally collected, prospective data. METHODS Data were extracted from the CholeS study, which examined and independently validated the outcomes on consecutive patients following non-emergency cholecystectomy across 166 hospitals in the UK and Ireland. Patients who received antibiotic prophylaxis were exact matched to those who did not on variables associated with antibiotic prophylaxis. The primary outcome of interest was superficial SSI, and secondary outcomes included deep SSI, readmissions, complications and re-interventions within 30 days. RESULTS Out of a total of 7327 patients included in the study, 4468 (61%) received antibiotic prophylaxis. These were matched to patients who did not receive antibiotic prophylaxis on a range of demographic and surgical factors, leaving 1269 pairs of patients for analysis. Within this cohort, patients receiving antibiotic prophylaxis had significantly lower rates of superficial SSI (0.7% vs. 2.3%, p = 0.001) and all-cause complications (5.8 vs. 8.0%, p = 0.031), but similar rates of deep SSI (1.0 vs. 1.4%, p = 0.473), readmissions (5.2 vs. 6.2%, p = 0.302) and re-interventions (2.6 vs. 3.7%, p = 0.093). The number needed to treat to prevent one superficial SSI was 45 (95% confidence interval 24-662). CONCLUSIONS Antibiotics appear effective at reducing SSI after non-emergency cholecystectomy. However, due to the high number needed to treat it is unclear whether they provide a worthwhile clinical benefit to patients.
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Affiliation(s)
- Ravinder S Vohra
- Nottingham Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - James Hodson
- Institute of Translational Medicine (ITM), University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2G, UK
| | - Sandro Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ewen A Griffiths
- Department of Upper Gastro-Intestinal Surgery, University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Basu S, Kumar Sarkar P, Ray Chaudhury S, Sankar Mondal S. THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN PATIENTS UNDERGOING ELECTIVE CHOLECYSTECTOMY- A RANDOMISED PLACEBO CONTROLLED RECIPIENT BLIND TRIAL. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES 2017; 6:3676-3680. [DOI: 10.14260/jemds/2017/794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Macano C, Griffiths EA, Vohra RS. Current practice of antibiotic prophylaxis during elective laparoscopic cholecystectomy. Ann R Coll Surg Engl 2017; 99:216-217. [PMID: 28071948 PMCID: PMC5450289 DOI: 10.1308/rcsann.2017.0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Current guidelines do not recommend antibiotic prophylaxis in elective laparoscopic cholecystectomy. Despite this, there is wide variation in antibiotic prophylaxis during cholecystectomy in population-based studies. The aim of this survey was to establish the current rationale for antibiotic prophylaxis in elective laparoscopic cholecystectomy. METHODS A short questionnaire was designed and disseminated across collaborators for a population-based study investigating outcomes following cholecystectomy and via the Association of Upper Gastrointestinal Surgeons, Researchgate and Surginet membership. RESULTS Responses were received from 234 people; 50.9% had no written policy for the use of prophylactic antibiotics in elective cholecystectomy; 5.6% never used antibiotics, while 30.8% always did and 63.7% selectively used antibiotics. Contamination with bile, stones and pus were scenarios in which antibiotics were most commonly used in selective practices to reduce infective complications. Interestingly, 87% of respondents would be happy to participate in a trial investigating the effectiveness of antibiotics in elective laparoscopic cholecystectomy where contamination has occurred. CONCLUSIONS The disparity between current practice and guidelines appears to arise because of a lack of evidence to show that antibiotics reduce surgical site infection following elective laparoscopic cholecystectomy where contamination has occurred. This question needs to addressed before practice will change.
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Affiliation(s)
- Caw Macano
- Department of Upper Gastrointestinal Surgery, University Hospitals of North Midlands, Stoke-on-Trent , Staffordshire , UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, University Hospitals, Birmingham NHS Foundation Trust , Birmingham , UK
| | - R S Vohra
- West Midlands Research Collaborative, University of Birmingham , Birmingham , UK
- Department of Oesophago-Gastric Surgery, Nottingham University Hospitals , Nottingham , UK
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BEST-PRACTICE GUIDELINES FOR FIELD-BASED SURGERY AND ANESTHESIA ON FREE-RANGING WILDLIFE. II. SURGERY. J Wildl Dis 2016; 52:S28-39. [PMID: 26845297 DOI: 10.7589/52.2s.s28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The principles of surgical asepsis apply to field surgeries with few exceptions. The minimum level for performance of surgeries in the field on free-ranging animals should be the same as for domestic animals undergoing surgery in animal hospitals. Surgeries in the field are typically done as part of research and management projects and usually involve a combination of biologists and veterinarians with the possibility of conflicts in scientific cultures. This article outlines a minimum standard of care for field surgeries and will serve as a resource for Institutional Animal Care and Use Committees and biologists and veterinarians planning projects that involve surgeries on free-ranging wildlife in field conditions.
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BEST PRACTICE GUIDELINES FOR FIELD-BASED SURGERY AND ANESTHESIA ON FREE-RANGING WILDLIFE. II. SURGERY. J Wildl Dis 2015. [DOI: 10.7589/jwdi-52-01s1-05.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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15
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Sandblom G, Videhult P, Crona Guterstam Y, Svenner A, Sadr-Azodi O. Mortality after a cholecystectomy: a population-based study. HPB (Oxford) 2015; 17:239-43. [PMID: 25363135 PMCID: PMC4333785 DOI: 10.1111/hpb.12356] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/22/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The trade-off between the benefits of surgery for gallstone disease for a large population and the risk of lethal outcome in a small minority requires knowledge of the overall mortality. METHODS Between 2007 and 2010, 47 912 cholecystectomies for gallstone disease were registered in the Swedish Register for Cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) (GallRiks). By linkage to the Swedish Death Register, the 30-day mortality after surgery was determined. The age- and sex-standardized mortality ratio (SMR) was estimated by dividing the observed mortality with the expected mortality rate in the Swedish general population 2007. The Charlson Comorbidity Index (CCI) was estimated by International Classification of Diseases (ICD) codes retrieved from the National Patient Register. RESULTS Within 30 days after surgery, 72 (0.15%) patients died. The 30-day mortality was close [SMR = 2.58; 95% confidence interval (CI): 2.02-3.25] to that of the Swedish general population. In multivariable logistic regression analysis, predictors of 30-day mortality were age >70 years [odds ratio (OR) 7.04, CI: 2.23-22.26], CCI > 2 (OR 1.93, CI: 1.06-3.51), American Society of Anesthesiologists (ASA) > 2 (OR 13.28, CI: 4.64-38.02), acute surgery (OR 10.05, CI:2.41-41.95), open surgical approach (OR 2.20, CI: 1.55-4.69) and peri-operative complications (OR 3.27, CI: 1.74-6.15). DISCUSSION Mortality after cholecystectomy is low. Co-morbidity and peri-operative complications may, however, increase mortality substantially. The increased mortality risk associated with open cholecystectomy could be explained by confounding factors influencing the decision to perform open surgery.
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Affiliation(s)
- Gabriel Sandblom
- Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska InstituteStockholm, Sweden,Correspondence, Gabriel Sandblom, Institution of Clinical Sciences, Intervention and Technology, Karolinska Institutet, 141 86 Stockholm, Sweden. Tel.: +46 8 58 58 00 00. Fax: +46 8 58 58 23 40. E-mail:
| | - Per Videhult
- Department of Surgery, Västerås HospitalVästerås, Sweden
| | | | - Annika Svenner
- Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska InstituteStockholm, Sweden
| | - Omid Sadr-Azodi
- Division of Surgery, Institution of Clinical Sciences, Intervention and Technology, Karolinska InstituteStockholm, Sweden
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Darkahi B, Sandblom G, Liljeholm H, Videhult P, Melhus Å, Rasmussen IC. Biliary microflora in patients undergoing cholecystectomy. Surg Infect (Larchmt) 2014; 15:262-5. [PMID: 24801654 DOI: 10.1089/sur.2012.125] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The management of acute cholecystitis requires a sound knowledge of the biliary microflora. METHODS Bile samples were taken for culture according to a standard routine during all cholecystectomies performed from April 2007 to February 2009 in the Department of Surgery at Enköping Hospital. The use of antibiotics within the 3-mo period before surgery, indication for surgery, prophylactic antibiotics, and post-operative complications were recorded prospectively. RESULTS Altogether, 246 procedures were performed during the study period, of which 149 (62%) were done on women. The mean (±SD) age of the study subjects was 49±16 y. Bacterial growth was seen in cultures from 34 (14%) of the subjects. The mean age of subjects with positive cultures was 64 y and that of subjects with negative cultures was 47 y (p<0.001). Positive culture was seen in 16 (31%) of the 51 patients who underwent operations for acute cholecystitis, whereas positive cultures were obtained in 18 of 195 patients without acute cholecystitis (9%) (p<0.001). Resistance to ampicillin was recorded in three of 34 (9%) of the cultures with bacterial growth, to co-trimoxazole in one of the 34 (3%) cultures, to fluoroquinolones in one of the 34 (3%) cultures, and to cephalosporins in one of the 34 (3%) cultures. Resistance to piperacillin-tazobactam was not observed in any of the cultures. In multivariable logistic regression analysis, a positive culture was the only factor significantly associated with risk for post-operative infectious complications (p<0.05). DISCUSSION Bacterial growth in the bile is observed more often in patients undergoing surgery for acute cholecystitis. The microflora of the bile is probably important for the outcome of surgery, but further studies are required for assessing the effectiveness of measures for preventing infectious post-operative complications.
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Affiliation(s)
- Bahman Darkahi
- 1 Department of Surgery, Enköping Hospital , Enköping, Sweden
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Single-incision laparoscopic cholecystectomy: comparison analysis of feasibility and safety. Surg Laparosc Endosc Percutan Tech 2012; 22:108-13. [PMID: 22487621 DOI: 10.1097/sle.0b013e3182456e3b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To maintain operative safety, patient selection criteria for single-incision laparoscopic cholecystectomy (SILC) are more stringent than that for traditional laparoscopic cholecystectomy (TLC). No other method could demonstrate the same feasibility and safety as TLC because the patient selection criteria were too restrictive for SILC to compare with TLC. In this study, we conducted a comparative study between our original SILC and TLC for demonstrating similar feasibility and safety among patients who had the same selection criteria as that for TLC. A statistical comparison between 114 patients of SILC and 201 patients of TLC was conducted during the same time period. The preoperative patient characteristics for SILC and TLC showed no statistical difference. In the operative result analysis, a significant disadvantage of SILC was the prolongation of operative time by only 15 minutes. The original SILC was as feasible and safe as TLC and virtually scarless cholecystectomy could be performed without any selection criteria. This was performed using only 2 trocars from an umbilical incision and 2 incisionless extracorporeal retraction devices.
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Sajid MS, Hutson K, Akhter N, Kalra L, Rapisarda IF, Bonomi R. An Updated Meta-Analysis on the Effectiveness of Preoperative Prophylactic Antibiotics in Patients Undergoing Breast Surgical Procedures. Breast J 2012; 18:312-7. [DOI: 10.1111/j.1524-4741.2012.01248.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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