Single-Dose Versus Multiple-Dose Prophylactic Antibiotics in Minimally Invasive Colorectal Surgery: A Propensity Score Matched Analysis.

Abstract

Background: Recent guidelines about preventing surgical site infections (SSIs) recommend against the administration of prophylactic antibiotics after surgery. However, many colorectal surgeons still prefer prolonged use of prophylactic antibiotics. While minimally invasive surgery (MIS) has become the standard for colorectal cancer surgery, there were few studies about proper dose of prophylactic antibiotics in minimally invasive colorectal surgery.

Methods: This is a retrospective study. All patients underwent elective colorectal cancer surgery using MIS. Intravenous cefotetan was administered as a prophylactic antibiotic. Two groups were classified according to the dose of prophylactic antibiotics: a group using a single dose preoperatively (single-dose group) and a group using a preoperative single dose plus additional doses within 24 hours after surgery (multiple-dose group). The SSI rates between the two groups were compared before and after propensity score matching (PSM). Risk factors of SSIs were assessed using univariate and multivariable analysis.

Results: There were 902 patients in the single-dose group and 330 patients in the multiple-dose group. After PSM, 320 patients were included in each group. There were no differences in baseline characteristics and surgical outcomes except the length of hospital stay. SSI rates were not different between the two groups before and after PSM (before 2.0% vs. 2.1%, P = 0.890; after 0.9% vs. 1.9%, P = 0.505). In multivariable analysis, American Society of Anesthesiologists class 3, rectal surgery, intraoperative transfusion, and larger tumor size were identified as independent factors associated with SSI incidence.

Conclusion: A single preoperative dose of prophylactic antibiotics may be sufficient to prevent SSIs in elective MIS for colorectal cancer.