Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy . Conclusions of a large prospective multicenter quality assurance study in Germany.
BACKGROUND
Postoperative infection following cholecystectomy poses a significant threat to recovery, with major cost repercussions. Though antimicrobial prophylaxis is commonly practiced, its value - particularly in laparoscopic cholecystectomy - has not yet been adequately documented.


METHODS
In a prospective multicenter quality assurance study in 28 German hospitals, an analysis of data collected on 4,477 patients undergoing conventional (n = 1,349) or laparoscopic (n = 3,128) cholecystectomy was performed; 2,217 patients received and 2,260 did not obtain perioperative antibiotic cover.


RESULTS
Postoperative infections occurred in a total of 136 patients, with infection rates of 5.0% in those without prophylaxis, 0.8% in those on ceftriaxone, and 1.2% in those on other antibiotic regimens. Patients receiving prophylaxis fared significantly better than those with no prophylaxis in terms of the rate of postoperative wound infections, chest infections, other complications, reoperation and mortality.


CONCLUSIONS
Neither laparoscopic nor conventional open cholecystectomy should be performed without adequate perioperative antimicrobial prophylaxis in future, especially since such measures also reduce hospital stay and hence the costs.
Lippert
H
H
Department of Surgery, Otto von Guericke University, Magdeburg, Germany.
Gastinger
J
J
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000191:economics / Q000517:prevention & control; D002763:Cholecystectomy / Q000191:economics; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D017046:Cost Savings; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D014946:Wound Infection / Q000517:prevention & control
D000900:Anti-Bacterial Agents