title: Prophylactic antibiotics for hemorrhoidectomy: are they really needed?
abstract: BACKGROUND
  Hemorrhoidectomy is considered by many to be a contaminated operation that requires antibiotic prophylaxis to lower the incidence of surgical site infection. In reality, little evidence exists to either support or refute the use of antibiotic prophylaxis in this setting.
  
  
  OBJECTIVE
  This study aimed to determine if antibiotic prophylaxis is associated with reduced incidence of postoperative surgical site infection following hemorrhoidectomy.
  
  
  METHODS
  This is a retrospective database review.
  
  
  METHODS
  This study was conducted at multiple institutions.
  
  
  METHODS
  All patients undergoing hemorrhoidectomy with minimum 3-month follow-up were included.
  
  
  METHODS
  The primary outcome measure was the incidence of postoperative surgical site infection.
  
  
  RESULTS
  Eight hundred fifty-two patients met the inclusion criteria (50.1% female; mean age, 50.0 ± 13.7 years). The prevalence of preoperative risk factors for surgical site infection included 7.7% with a smoking history, 2.5% with diabetes mellitus, 0.8% receiving steroids, and 0.2% with Crohn's disease. Surgery was performed predominately for 3-column prolapsed internal and mixed internal/external hemorrhoidal disease. All surgeries performed were closed hemorrhoidectomies. Antibiotic prophylaxis was used in a fewer number of cases (41.3% vs 58.7%). Overall, there were only 12 documented postoperative infections identified, producing an overall incidence of 1.4%. Of those patients who developed postoperative surgical site infections, 9 (75%) did not receive antibiotic prophylaxis (p = 0.25). On multivariate regression analysis, no perioperative risk factor was associated with an increased risk of developing a posthemorrhoidectomy surgical site infection. Conversely, there were no adverse antibiotic-related complications such as Clostridium difficile colitis or antibiotic-associated diarrhea in those receiving antibiotic prophylaxis.
  
  
  CONCLUSIONS
  This study was limited by the retrospective nature of the analysis.
  
  
  CONCLUSIONS
  Postoperative surgical site infection is an exceedingly rare event following hemorrhoidectomy. Antibiotic prophylaxis does not reduce the incidence of postoperative surgical site infection, and its routine use appears unnecessary.
authors: 1Department of Surgery, Madigan Army Medical Center, Tacoma, Washington 2Division of Colorectal Surgery, Case Medical Center, Cleveland, Ohio 3Division of Colorectal Surgery, Huntington Hospital/North Shore-LIJ Health System, Great Neck, New York 4Department of Surgery, University of Cincinnati, Cincinnati, Ohio 5Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 6Division of Colorectal Surgery, Meridian Health System, Tinton Falls, New Jersey.
authors: Daniel W
authors: DW
authors: Nelson
authors: Brad J
authors: BJ
authors: Champagne
authors: David E
authors: DE
authors: Rivadeneira
authors: Brad R
authors: BR
authors: Davis
authors: Justin A
authors: JA
authors: Maykel
authors: Howard M
authors: HM
authors: Ross
authors: Eric K
authors: EK
authors: Johnson
authors: Scott R
authors: SR
authors: Steele
mesh_terms: D019072:Antibiotic Prophylaxis; D015897:Comorbidity; D005260:Female; D061865:Hemorrhoidectomy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*