2008 Annual Meeting Abstracts

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Background and Purpose: The role of prophylactic antibiotics in laparoscopic cholecystectomy in low risk patients is controversial. Several randomized controlled trials (RCTs) have reported conflicting results. We conducted a meta-analysis to evaluate the efficacy of prophylactic antibiotics in low risk patients undergoing laparoscopic cholecystectomy.
Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched (through 10/07). RCTs comparing prophylactic antibiotics to placebo or no treatment in the setting of low-risk laparoscopic cholecystectomy were included. Standard forms were used to extract data by two independent reviewers. The effects of prophylactic antibiotics were analyzed by calculating pooled estimates of all infections (superficial wound infections, sub-hepatic fluid collections, and distant infections) and length of hospital stay. Separate analyses were performed for each outcome by using odds ratio (OR) or weighted mean difference (WMD). Both random and fixed effect models were used. Publication bias was accessed by funnel plot. All studies were graded by Jadad scores. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency.
Results: Eight RCTs (N=1,361) met the inclusion criteria. The antibiotics used in the trials were: cefazolin (3 trials), cefotaxim (2 trials), cefotetan (1 trial), cefuroxime (1 trial), & cefotetan/cefazolin (1 trial). Antibiotics were administered preoperatively in all studies. 3 trials used multiple doses; first dose pre-operatively and other doses post-operatively. There was no significant heterogeneity among the studies (I2=0%). Quality score ranged from 2-5. Prophylactic antibiotics did not decrease the odds of post-operative infective complications (including superficial, deep and distant infections) (OR 0.64, 95% CI: 0.31-1.30, p=0.22), superficial wound infections (OR 0.74, 95% CI 0.30-1.82, p=0.52), sub-hepatic fluid collections (OR 1.03, 95% CI: 0.21-5.13, p=0.98), or distant infections (OR 0.50, 95% CI: 0.13-1.97, p=0.32). Prophylactic antibiotics also did not alter the length of hospital stay (WMD 0.02, 95%CI -0.10-0.14, p=0.77). Funnel plot did not reveal the presence of publication bias. Pooling of data from high quality studies (Jadad score > 3) also did not reveal a reduction in the odds for total infection (OR 0.75, 95% CI 0.35-1.63, p= 0.72).
Conclusions: Prophylactic antibiotics do not prevent infections in low risk patients undergoing laparoscopic cholecystectomy.

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