M.A. Colak1, B. Rachwal3, K.J. Van Arendonk2,3, S.K. Rasmussen1,2,3, J.D. Nathan1,2,3 2Ohio State University, Department Of Surgery, Columbus, OH, USA 3Nationwide Children’s Hospital, Department Of Pediatric Surgery, Columbus, OH, USA 1Nationwide Children’s Hospital, Department Of Abdominal Transplant And Hepatopancreatobiliary Surgery, Columbus, OH, USA
Introduction:
Some guidelines have recently recommended against prophylactic antibiotics (PA) in children undergoing elective laparoscopic cholecystectomy, but variability in practice exists. We aim to evaluate the impact of PA on postoperative surgical site infections (SSIs).
Methods:
Children (age ≤18 years) undergoing elective laparoscopic cholecystectomy for cholelithiasis, chronic cholecystitis, or other disorders of gallbladder between 2021-2022 were identified using the National Surgical Quality Improvement Program-Pediatric Surgical Antibiotic Prophylaxis database. Those with acute cholecystitis, pancreatitis, and cholangitis were excluded. Preoperative demographics and postoperative outcomes were compared between those who did and did not receive PA. Multivariable logistic regression was used to evaluate the association between PA and postoperative SSIs.
Results:
Among 3374 patients, 2622 (77.7%) had cholelithiasis, 261 (7.7%) had chronic cholecystitis, and 491 (14.6%) had other gallbladder disorders. PA were used in 3034 (89.9%). Of these, 2236 (73.7%) received cefazolin, 540 (17.8%) received cefoxitin, 98 (3.2%) received clindamycin, and 165 (5.4%) received other drugs. Antibiotics were re-dosed in only 44 (1.5%). PA use was similar across diagnosis groups (90.2% for cholelithiasis vs 90.4% for chronic cholecystitis vs 88.4% for other gallbladder disorders, p=0.5). Median age (15.3 [13.8, 16.6] vs 15.3 [13.6,16.6], p=0.8), sex distribution (80.2% vs 79.7% female, p=0.8), and presence of preoperative comorbidities (26.8% vs 27.7%, p=0.7) were similar between those who did and did not receive PA. Patients who received PA had fewer superficial SSIs (1.0% vs 2.4%, p=0.03). Organ/space SSIs (0.1% vs 0.6%, p=0.05) and wound disruption/dehiscence (0.1% vs 0%, p=1.000) were uncommon but similar between those who did and did not receive PA. No deep SSIs occurred in either group. Overall, the risk of any SSI (1.0% vs 2.9%, p=0.006) was lower among those who received PA. There were no postoperative Clostridium difficile infections in either group. Unplanned reoperation (0.5% vs 0.3%, p=1.0) and unplanned readmission (1.8% vs 2.7%, p=0.3) rates were similar between those who did and did not receive PA. Adjusted for diagnosis, those who received PA were 65% less likely (adjusted OR 0.35, 95% CI 0.17-0.72, p=0.004) to have a postoperative SSI (Table).
Conclusion:
Although the risk of SSI in children undergoing elective laparoscopic cholecystectomy was low, the use of PA was associated with a lower risk of SSI. As practices consider shifting away from routine PA for elective laparoscopic cholecystectomy, careful re-examination of SSI rates will be necessary to confirm these findings over time.