Outcomes of antibiotic prophylaxis in acute cholecystectomy in a population-based gallstone surgery registry

• BackgroundThe aim of this study was to assess the effect of antibiotic prophylaxis (AP) on postoperative infections in acute cholecystectomy.MethodsThe study was based on acute cholecystectomies registered in the nationwide Swedish Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) between 2006 and 2010. The association between AP and the risk of postoperative infectious complications was tested in a multivariable regression analysis, with stepwise addition of age, sex, duration of operation, indication for surgery, surgical approach (laparoscopic versus open) and American Society of Anesthesiologists (ASA) fitness grade as co-variables. Postoperative infections requiring antibiotic treatment and postoperative abscesses were defined as outcome measures.ResultsAP was given to 9549 (686 per cent) of 13 911 patients. Postoperative infections requiring antibiotic treatment occurred following 1070 procedures (77 per cent), including 805 patients (84 per cent) who received AP (P < 0001 versus patients without AP). Postoperative abscesses developed after 273 procedures (20 per cent), including 208 patients (22 per cent) who received AP (P = 0007). In univariable analysis, the odds ratio for development of infectious complications necessitating treatment with antibiotics was 142 (95 per cent confidence interval 123 to 164) for those who received APversus those who did not, and for postoperative abscesses it was 147 (111 to 195). In multivariable analysis, adjusting for confounders, the odds ratios were 093 (079 to 110) and 088 (064 to 121) respectively.ConclusionThe present study suggests that AP provides no benefit in acute cholecystectomy. No benefit from antibiotics

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