Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis.
BACKGROUND
The role of prophylactic antibiotics in laparoscopic cholecystectomy in low-risk patients is controversial. We conducted a meta-analysis to evaluate the efficacy of prophylactic antibiotics in low-risk patients (those without cholelithiasis or cholangitis) undergoing laparoscopic cholecystectomy.


METHODS
Multiple databases and abstracts were searched. Randomized controlled trials (RCTs) comparing prophylactic antibiotics to placebo or no antibiotics in low-risk laparoscopic cholecystectomy were included. The effects of prophylactic antibiotics were analyzed by calculating pooled estimates of overall infections, superficial wound infections, major infections, distant infections, and length of hospital stay. Separate analyses were performed for each outcome by using odds ratio or weighted mean difference. Both random and fixed effects models were used. Publication bias was assessed by funnel plot. Heterogeneity among studies was assessed by calculating I (2) measure of inconsistency.


RESULTS
Nine RCTs (N = 1,437) met the inclusion criteria. No statistically significant reduction was noted for those receiving prophylactic antibiotics and those who did not for overall infectious complications (p = 0.20), superficial wound infections (p = 0.36), major infections (p = 0.97), distant infections (p = 0.28), or length of hospital stay (p = 0.77). No statistically significant publication bias or heterogeneity were noted.


CONCLUSIONS
Prophylactic antibiotics do not prevent infections in low-risk patients undergoing laparoscopic cholecystectomy.
Choudhary
Abhishek
A
Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO, USA.
Bechtold
Matthew L
ML
Puli
Srinivas R
SR
Othman
Mohamed O
MO
Roy
Praveen K
PK
D019072:Antibiotic Prophylaxis; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D003428:Cross Infection / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
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