title: Antibiotic prophylaxis for the prevention of surgical site infection after tension-free hernia repair: a Bayesian and frequentist meta-analysis.
abstract: BACKGROUND
  Efficacy of antibiotic prophylaxis for the prevention of surgical site infection (SSI) after open tension-free hernia repair remains controversial. In light of additional data, the aim of this study was to determine whether antibiotic prophylaxis reduces SSI after hernia repair.
  
  
  METHODS
  We conducted a systematic review and meta-analysis to identify randomized controlled trials comparing antibiotic prophylaxis and the subsequent incidence of SSI after inguinal or femoral hernia repair. The primary outcomes measure was the incidence of SSI. Subgroup analysis was evaluated by stratifying the categories of SSI. The meta-analysis was performed using Bayesian and frequentist methods.
  
  
  RESULTS
  Twelve studies were included in this meta-analysis; 1,902 patients received antibiotic prophylaxis and the other 1,936 patients were allocated to the control group. Incidence of SSI was 47 (pooled rate 3.0%) in the antibiotic group and 91 (6.0%) in the control group. The number needed to treat to prevent 1 episode of SSI is 41. The Bayesian meta-analysis yielded a significant reduction of SSI in the antibiotic group (odds ratio = 0.49; 95% credible interval 0.25-0.81). Subgroup analysis showed that an antibiotic prophylaxis was beneficial for the prevention of superficial SSI (odds ratio = 0.40; 95% credible interval 0.12-0.98), but not beneficial for prevention of deep SSI (odds ratio = 0.59; 95% credible interval 0.11-3.20). Also, the results were similar to those with frequentist methods.
  
  
  CONCLUSIONS
  This meta-analysis suggests that antibiotic prophylaxis is efficacious for the prevention of SSI after open mesh hernia repair.
authors.affiliation: Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. Electronic address: mazaki.takero@nihon-u.ac.jp.
authors.forename: Takero
authors.initials: T
authors.lastname: Mazaki
authors.forename: Kazunari
authors.initials: K
authors.lastname: Mado
authors.forename: Hideki
authors.initials: H
authors.lastname: Masuda
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
mesh_terms: D019072:Antibiotic Prophylaxis; D001499:Bayes Theorem; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D015994:Incidence; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
keywords: CrI; DSSI; OR; SSI; SSSI; credible interval; deep surgical site infection; odds ratio; superficial surgical site infection; surgical site infection