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Are They Necessary?

Andrew Higgins, MD; Jeremy London, MD; Scott Charland, PharmD; Erick Ratzer, MD; Jeffrey Clark, MD; William Haun, MD; D. Patrick Maher, MD

Arch Surg. 1999;134:611-614.

Hypothesis  Prophylactic antibiotic treatment in elective laparoscopic cholecystectomy does not lower the already low infection rate associated with this procedure.

Design and Setting  Prospective double-blind randomized trial at a community-based training hospital.

Patients  Four hundred fifty patients undergoing elective laparoscopic cholecystectomy were randomized into 1 of 3 treatment arms: (1) preoperative cefotetan disodium, 1 g intravenously; (2) preoperative cefazolin, 1 g intravenously; and (3) intravenous placebo. There were no demographic differences between groups in age, smoking history, American Society of Anesthesiologists score, infection risk class, time of antibiotic administration prior to surgery, and type of skin preparation.

Interventions  Laparoscopic cholecystectomy was attempted in all cases; however, 10 patients required conversion to an open cholecystectomy and they were included in the statistical analysis. Preoperatively, all patients were randomized in a blinded manner and received cefotetan, cefazolin, or placebo intravenously.

Results  There were 10 postoperative infections. In the cefotetan group, there were 3 cases of superficial surgical site infections. In the cefazolin group, there were 2 superficial surgical site infections—1 pneumonia and 1 rhinosinusitis. In the placebo group, there were 2 superficial surgical site infections and 1 urinary tract infection. The overall infection rate in this series was 2.4%. Follow-up was performed at routine postoperative visits and by telephone contact. Data were evaluated using the ² test and analysis of variance with Duncan post hoc test (P<.05).

Conclusion  Based on our data, use of prophylactic antibiotics does not decrease the rate of wound infections in elective laparoscopic cholecystectomy.

From Exempla Saint Joseph Hospital (Drs Higgins, London, Ratzer, Clark, Haun, and Maher), Roche Pharmaceuticals (Dr Charland), and Kaiser Permanente (Dr Maher), Denver, Colo.

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