Division of Surgery, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Br J Surg. 2014 Jan;101(2):69-73. doi: 10.1002/bjs.9369. Epub 2013 Dec 16.
The aim of this study was to assess the effect of antibiotic prophylaxis (AP) on postoperative infections in acute cholecystectomy.
The study was based on acute cholecystectomies registered in the nationwide Swedish Register for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) between 2006 and 2010. The association between AP and the risk of postoperative infectious complications was tested in a multivariable regression analysis, with stepwise addition of age, sex, duration of operation, indication for surgery, surgical approach (laparoscopic versus open) and American Society of Anesthesiologists (ASA) fitness grade as co-variables. Postoperative infections requiring antibiotic treatment and postoperative abscesses were defined as outcome measures.
AP was given to 9549 (68.6 per cent) of 13 911 patients. Postoperative infections requiring antibiotic treatment occurred following 1070 procedures (7.7 per cent), including 805 patients (8.4 per cent) who received AP (P < 0.001 versus patients without AP). Postoperative abscesses developed after 273 procedures (2.0 per cent), including 208 patients (2.2 per cent) who received AP (P = 0.007). In univariable analysis, the odds ratio for development of infectious complications necessitating treatment with antibiotics was 1.42 (95 per cent confidence interval 1.23 to 1.64) for those who received AP versus those who did not, and for postoperative abscesses it was 1.47 (1.11 to 1.95). In multivariable analysis, adjusting for confounders, the odds ratios were 0.93 (0.79 to 1.10) and 0.88 (0.64 to 1.21) respectively.
The present study suggests that AP provides no benefit in acute cholecystectomy.
本研究旨在评估抗生素预防（AP）对急性胆囊切除术术后感染的影响。
本研究基于 2006 年至 2010 年期间在全国性瑞典胆囊结石手术和内镜逆行胰胆管造影术（GallRiks）登记处登记的急性胆囊切除术。在多变量回归分析中，通过逐步添加年龄、性别、手术持续时间、手术指征、手术途径（腹腔镜与开放）和美国麻醉师协会（ASA）健康状况等级作为协变量，测试 AP 与术后感染性并发症风险之间的关系。需要抗生素治疗的术后感染和术后脓肿被定义为结局指标。
在 13911 例患者中，9549 例（68.6%）接受了 AP。术后需要抗生素治疗的感染发生在 1070 例手术中（7.7%），其中 805 例（8.4%）接受 AP 的患者（P<0.001 与未接受 AP 的患者相比）。术后脓肿发生在 273 例手术中（2.0%），其中 208 例（2.2%）接受 AP 的患者（P=0.007）。在单变量分析中，与未接受 AP 的患者相比，接受 AP 的患者发生需要抗生素治疗的感染性并发症的优势比为 1.42（95%置信区间 1.23 至 1.64），对于术后脓肿的优势比为 1.47（1.11 至 1.95）。在多变量分析中，调整混杂因素后，优势比分别为 0.93（0.79 至 1.10）和 0.88（0.64 至 1.21）。
本研究表明，AP 在急性胆囊切除术中没有益处。
Zotero 插件