Surgical Antimicrobial Prophylaxis in Low-risk Cholecystectomies is Associated With Fewer Surgical Site Infections

Objective: To assess whether administration of surgical antimicrobial prophylaxis (SAP) versus absence of SAP is associated with a decreased risk of surgical site infections (SSIs) after low-risk cholecystectomies (LR-CCEs). Background: Current guidelines do not recommend routine SAP administration before LR-CCE. Methods: This cohort study included adult patients who underwent LR-CCE and were documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 66 Swiss hospitals. LR-CCE was specified as elective endoscopic surgery, age <70, no active cholecystitis, ASA score <3, operating time <120 minutes without implantation of foreign material. Exposure was defined as the administration of cefuroxime or cefazoline ± metronidazole within 120 minutes before incision versus no SAP administration. Our main outcome was the occurrence of SSI until day 30. Logistic regression models were used to adjust for institutional, patient, and perioperative variables. Results: Of 44,682 surveilled adult patients undergoing cholecystectomy, 12,521 [8726 women (69.7%); median (interquartile range) age, 49.0 (38.1–58.2) years] fulfilled the inclusion criteria. SSI was identified in 143 patients (1.1%). SAP was administered in 9269 patients (74.0%) and was associated with a lower SSI rate (adjusted odds ratio, 0.50; 95% CI, 0.35–0.70; P < 0.001). The number needed to treat to prevent 1 SSI episode is 100. Conclusions: The overall LR-CCE SSI rate was 1.1%. SAP was associated with a 50% lower overall SSI rate. Patients undergoing LR-CCE may benefit from routine SAP.