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Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Lack of need or lack of evidence?
- Source :
- Surgical endoscopy. 18(4)
- Publication Year :
- 2003
-
Abstract
- Background: The need to administer antibiotic prophylaxis (ABP) during laparoscopic cholecystectomy (LC) is still a matter of significant controversy. The purpose of this study was to resolve this issue by performing a meta-analysis of the available randomized controlled trials (RCT) on this topic. Methods: Papers identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. The outcome measures were the rates of all perioperative infections, the rates of surgical site infections, and the rates of infections at other sites. Results were examined for 974 patients randomized to ABP or placebo prior to LC in six RCT published from 1997 to 2001. Results: The cumulative rates of all infections were 2.8% in the ABP group and 4.4% in the placebo group. The pooled odds ratio (OR) (95% confidence interval [CI]) was 0.69 (0.34–1.43; p = 0.32). The cumulative rates of surgical site infections were 2.1% in the ABP group and 2.9% in the placebo group. The pooled OR (95% CI) was 0.82 (0.36–1.86; p = 0.63). The cumulative rates of infections at other sites were 0.7% in the ABP group and 1.5% in the placebo group. Pooled OR (95% CI) was 0.82 (0.18–1.90; p = 0.37). No significant heterogeneity was found in any data pooling. Conclusions: Based on the available evidence, there appears to be no need to administer routine ABP to low-risk patients during LC. However, the number of patients enrolled to date into RCT is insufficient to avoid a type II error. A large and well-designed trial is urgently needed to find a conclusive answer to this question.
- Subjects :
- Antibiotic prophylaxis
Cholecystectomy
Laparoscopy
Meta-analysis
Randomized controlled trials
law.invention
Randomized controlled trial
law
Odds Ratio
Medicine
Prospective Studies
Bibliographic
Antibacterial agent
Randomized Controlled Trials as Topic
Evidence-Based Medicine
adult
Incidence
placebo
aged
antibiotic prophylaxis
article
cholecystectomy
clinical trial
controlled clinical trial
controlled study
elective surgery
female
gallstone
human
infection rate
infectious complication
laparoscopic surgery
major clinical study
male
meta analysis
outcomes research
postoperative infection
practice guideline
priority journal
randomized controlled trial
sampling
surgical infection
wound infection
Antibiotic Prophylaxis
Cholecystectomy, Laparoscopic
Confidence Intervals
Databases, Bibliographic
Humans
Randomized Controlled Trials
Surgical Wound Infection
Treatment Outcome
Chemoprophylaxis
medicine.medical_specialty
Placebo
Databases
Laparoscopic
Internal medicine
business.industry
Perioperative
Odds ratio
Surgery
Settore MED/18 - Chirurgia Generale
business
Subjects
Details
- ISSN :
- 14322218
- Volume :
- 18
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Surgical endoscopy
- Accession number :
- edsair.doi.dedup.....db68d67bd39fdbcaa37e29e23e4578e5