title: Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey.
abstract: OBJECTIVE
  Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent.
  
  
  METHODS
  Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of England on their practices and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair. Local prophylaxis guidelines for the participating hospital sites were also determined.
  
  
  RESULTS
  The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons, a 93 % response rate. Overall, a large majority of hospital guidelines (22/28) and surgeons' personal beliefs (192/229, 84 %) supported the use of single-dose pre-operative intravenous antibiotic prophylaxis in inguinal hernia repair, although there was considerable variation in the regimens in use. The most widely used regimen was intravenous co-amoxiclav (1.2 g). Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure, although many incorrectly believed that they were following these.
  
  
  CONCLUSIONS
  In the south-east of England, there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure. It is therefore likely to be extremely difficult to conduct further randomised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure.
authors.affiliation: c/o National Centre for Bowel Research and Surgical Innovation, 1st Floor Abernathy Building, 2 Newark St, Whitechapel, London, E1 2AT, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Aiken
authors.forename: J B
authors.initials: JB
authors.lastname: Haddow
authors.forename: N R A
authors.initials: NR
authors.lastname: Symons
authors.forename: S
authors.initials: S
authors.lastname: Kaptanis
authors.forename: A C
authors.initials: AC
authors.lastname: Katz-Summercorn
authors.forename: D
authors.initials: D
authors.lastname: Debnath
authors.forename: H
authors.initials: H
authors.lastname: Dent
authors.forename: S
authors.initials: S
authors.lastname: Tayeh
authors.forename: V
authors.initials: V
authors.lastname: Kung
authors.forename: S
authors.initials: S
authors.lastname: Clark
authors.forename: J
authors.initials: J
authors.lastname: Gahir
authors.forename: S
authors.initials: S
authors.lastname: Dindyal
authors.forename: S
authors.initials: S
authors.lastname: Farag
authors.forename: A
authors.initials: A
authors.lastname: Lazaridis
authors.forename: C P
authors.initials: CP
authors.lastname: Bretherton
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.forename: A
authors.initials: A
authors.lastname: Currie
authors.forename: H
authors.initials: H
authors.lastname: West
authors.forename: J
authors.initials: J
authors.lastname: Davies
authors.forename: S
authors.initials: S
authors.lastname: Arora
authors.forename: A
authors.initials: A
authors.lastname: Kheraj
authors.forename: B M
authors.initials: BM
authors.lastname: Stubbs
authors.forename: N
authors.initials: N
authors.lastname: Yassin
authors.forename: S
authors.initials: S
authors.lastname: Mallappa
authors.forename: G
authors.initials: G
authors.lastname: Garrett
authors.forename: S
authors.initials: S
authors.lastname: Hislop
authors.forename: A
authors.initials: A
authors.lastname: Bhangu
authors.forename: Y
authors.initials: Y
authors.lastname: Abbey
authors.forename: I
authors.initials: I
authors.lastname: Al-Shoek
authors.forename: U
authors.initials: U
authors.lastname: Ahmad
authors.forename: G
authors.initials: G
authors.lastname: Sharp
authors.forename: A
authors.initials: A
authors.lastname: Memarzadeh
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: F
authors.initials: F
authors.lastname: Ali
authors.forename: H
authors.initials: H
authors.lastname: Kaderbhai
authors.forename: C H
authors.initials: CH
authors.lastname: Knowles
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004739:England / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
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