Evaluation of preoperative antibiotic prophylaxis in clean-wound general surgery procedures: a propensity score-matched cohort study at a regional hospital.

IF 1.6 3区医学 Q2 SURGERY BMC Surgery Pub Date : 2024-10-07 DOI:10.1186/s12893-024-02616-8

Mai Charernsuk, Suppadech Tunruttanakul, Leenawat Jamjumrat, Borirak Chareonsil

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Abstract

Background: The administration of antibiotic prophylaxis for clean-wound surgeries is controversial among surgeons, despite guidelines suggesting its use. This study aimed to evaluate its effectiveness in preventing surgical site infections (SSIs) in clean-wound surgeries within a regional setting with varied practices regarding prophylaxis.

Materials and methods: This retrospective cohort study included four types of common general surgeries performed from March 2021 to February 2023 at a tertiary regional hospital in Thailand. The surgeries included skin/subcutaneous excision, thyroidectomy, inguinal hernia repair, and breast surgeries, all of which required regional or general anesthesia. Antibiotic prophylaxis was administered at the discretion of the attending surgeons. SSI diagnosis followed standard diagnostic criteria, involving reviewing medical records and the records of the infection control unit. Infection risk factors were examined. The primary outcome comparison used inverse probability treatment weighting of propensity scores, with covariate balance evaluated.

Results: Of the 501 surgeries identified, 84 were excluded, leaving 417 eligible for analysis. Among these patients, 233 received prophylactic antibiotics, for an SSI rate of 1.3%, while 184 did not receive antibiotics, for an SSI rate of 2.2%. A comparative analysis using propensity score weighting revealed no statistically significant difference in the incidence of SSI between the groups (risk ratio [95% confidence interval]: 0.54 (0.11, 2.50), p = 0.427).

Conclusion: In this practical setting, with the given study size, antibiotic prophylaxis in common general surgeries involving clean wounds did not significantly prevent SSIs. Routine use recommendations should be re-evaluated.

Trial registration: Not applicable as this study is a retrospective cohort study and not a clinical trial.

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评估清洁伤口普外科手术的术前抗生素预防：一家地区医院的倾向评分匹配队列研究。

背景：尽管相关指南建议在清洁伤口手术中使用抗生素预防，但外科医生对其使用仍存在争议。本研究旨在评估抗生素预防措施在预防清洁伤口手术（SSI）中的有效性：这项回顾性队列研究包括 2021 年 3 月至 2023 年 2 月期间在泰国一家三级地区医院进行的四种常见普通外科手术。这些手术包括皮肤/皮下切除术、甲状腺切除术、腹股沟疝修补术和乳房手术，所有这些手术都需要区域或全身麻醉。抗生素预防由主治医生决定。SSI 诊断遵循标准诊断标准，包括审查医疗记录和感染控制部门的记录。对感染风险因素进行了研究。主要结果比较采用了倾向得分的反概率治疗加权法，并对协变量平衡进行了评估：在确定的 501 例手术中，有 84 例被排除，剩下 417 例符合分析条件。在这些患者中，233 人接受了预防性抗生素治疗，SSI 感染率为 1.3%；184 人未接受抗生素治疗，SSI 感染率为 2.2%。使用倾向得分加权法进行的比较分析表明，两组的 SSI 发生率在统计学上没有显著差异（风险比 [95% 置信区间]：0.54（0.11，0.12，0.13））：结论：结论：在这一实际环境中，在特定的研究规模下，在涉及清洁伤口的普通外科手术中使用抗生素预防并不能显著预防 SSI。应重新评估常规使用建议：不适用，因为本研究是一项回顾性队列研究，而非临床试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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