Surgical infections and prophylactic antibiotics: 341 consecutive cases of gallbladder surgery in the era of laparoscopic surgery.

Overview

HYPOTHESIS: This study was undertaken to assess the use of prophylactic antibiotics (PA) in laparoscopic and open cholecystectomy with respect to the postoperative infection rate and the established criteria for PA use. METHODS: A total of 341 consecutive cases for 1994 were retrospectively analyzed. PA use was deemed appropriate if the patient: was over 70 years of age, had common duct stones, jaundice, or acute cholecystitis. RESULTS: The infection rate of patients having an open cholecystectomy was significantly greater than the laparoscopic group (12.9% versus 1.8%, p < .001). In the laparoscopic group of patients who met the criteria for PA and received PA there were no infections as compared with those who had criteria for but did not receive PA (0% versus 22%, p < .05). Only 27% of all elective cholecystectomy patients received cefazolin while 73% of patients received extended spectrum antibiotics. CONCLUSIONS: In 63.2% of patients antibiotics were used with no indication for PA. In 73% of patients, an extended spectrum drug was used when a less expensive and narrower spectrum agent would have sufficed. Open cholecystectomy has a significantly higher infectious rate than closed cholecystectomy.