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Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis

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Abstract

Background

Whether perioperative administration is required in elective laparoscopic cholecystectomy (LC) in patients with low risk of infection remains controversial.

Objective

To investigate whether perioperative use of prophylactic antibiotics during elective LC can reduce the incidence of postoperative infection using a meta-analysis.

Methods

Pubmed, Cochrane Library, Embase, and reference lists were searched up to October 26, 2020, for randomized controlled trials (RCTs) of the perioperative use of antibiotics during LC. A systematic review with meta-analysis, meta-regression, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) of the evidence was conducted. The Cochrane (RoB 2.0) tool was used to assess the risk of bias.

Result

A total of 14 RCTs were ultimately included in the meta-analysis, involving a total of 4360 patients. The incidence of surgical site infections, distant infections, and overall infections was investigated and the relationship with the perioperative use of prophylactic antibiotics during LC analyzed. The results indicated that in low-risk patients undergoing elective LC, prophylactic antibiotics reduce the incidence of surgical site infections (RR 0.66; 95% CI 0.45–0.98), with a moderate GRADE of evidence, distant infections (RR 0.34; 95% CI 0.16–0.73), with a low GRADE of evidence and overall infections (RR 0.57; 95% CI 0.40–0.80), with a moderate GRADE of evidence.

Conclusions

The present meta-analysis demonstrates that the perioperative use of antibiotics in LC is effective in low-risk patients, possibly reducing the incidence of surgical site infections, distant infections, and overall infections. However, in view of the limitations of the study, it is recommended that studies with a more rigorous design (for downgraded factors) and larger sample size should be conducted in the future so that the conclusions above can be further verified through key result indicators.

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Acknowledgements

Thanks for the guidance from Prof. Kehu Yang from the Evidence-Based Medicine Center of Lanzhou University.

Funding

This study was supported by the Key Laboratory of Evidence-Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant No. GSXZYZH2018006). Laboratory of Intelligent medical engineering of Gansu Province (Grant No. GSXZYZH2018001).

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Author notes

  1. Jia Yang, Shiyi Gong and Tingting Lu have contributed equally to this work.

Authors and Affiliations

  1. Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, Gansu, China

    Jia Yang, Shiyi Gong, Tingting Lu, Hongwei Tian, Wutang Jing, Yang Liu, Moubo Si, Caiwen Han & Tiankang Guo

  2. Ningxia Medical University, Yinchuan, 750004, Ningxia, China

    Jia Yang, Shiyi Gong & Yang Liu

  3. Institution of Evidence Based Medicine, Gansu Province Hospital, Lanzhou, 730000, Gansu, China

    Jia Yang, Shiyi Gong, Tingting Lu, Moubo Si, Caiwen Han, Kehu Yang & Tiankang Guo

  4. Evidence-Based Medicine Center, Lanzhou University, 222 West Donggang R.D., Lanzhou, 730000, Gansu, China

    Jia Yang, Shiyi Gong, Tingting Lu, Moubo Si, Caiwen Han & Kehu Yang

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  1. Jia Yang
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Jia Yang, Shiyi Gong, Tingting Lu, Hongwei Tian, Wutang Jing, Yang Liu, Moubo Si, Caiwen Han, Kehu Yang and Tiankang Guo have declared that no conflict of interest or financialties to disclose.

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Yang, J., Gong, S., Lu, T. et al. Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis. Surg Endosc 35, 6397–6412 (2021). https://doi.org/10.1007/s00464-021-08658-w

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