Tripler Army Medical Center, Honolulu, HI, 96815, USA.
Stanford University, Stanford, CA, 94305, USA.
Hernia. 2021 Feb;25(1):159-164. doi: 10.1007/s10029-020-02145-2. Epub 2020 Feb 27.
Antibiotic prophylaxis in inguinal hernia repair (IHR) is contentious in literature and practice. In low-risk patients, for whom evidence suggests antibiotic prophylaxis is unnecessary, many surgeons still advocate for its routine use. This study surveys prescription patterns of Department of Defense (DoD) general surgeons.
An anonymous survey was sent electronically to approximately 350 DoD general surgeons. The survey asked multiple-choice and free text answers about prescribing patterns and knowledge of current evidence for low-risk patients undergoing elective open inguinal hernia repair without mesh (OIHRWOM), open inguinal hernia repair with mesh (OIHRWM), or laparoscopic inguinal hernia repair (LIHR).
110 DoD general surgeons consented to participate. 58.6, 95 and 84.2% of surgeons always administer antibiotic prophylaxis in OIHRWOM, OIHRWM, and LIHR, respectively. 37.9, 70.9, and 63.2% of surgeons believe that it reduces rates of surgical site infection in OIHRWOM, OIHRWM, and LIHR, respectively. The most common reasons for empirically prescribing antibiotic prophylaxis include "I think the evidence supports it" (27 of 72 responses), "I would rather be conservative and safe" (15 of 72 responses), and "I am following my hospital/department guidelines" (9 of 72 responses). 11.8, 40.8, and 32.9% of surgeons believe current evidence supports antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively. 50, 18.4, and 22.4% of surgeons believe current evidence refutes antibiotic prophylaxis use in OIHRWM, OIHRWOM, and LIHR, respectively.
The survey results indicate that the majority of practicing DoD general surgeons still empirically prescribe surgical antibiotic prophylaxis in IHR despite more conflicting opinions that it has no meaningful effect or that current evidence does not supports its use.
在腹股沟疝修补术（IHR）中，抗生素预防一直存在争议，既有文献也有实践。对于证据表明不需要抗生素预防的低危患者，许多外科医生仍主张常规使用抗生素。本研究调查了美国国防部（DoD）普通外科医生的处方模式。
我们向大约 350 名 DoD 普通外科医生发送了一份匿名电子调查。该调查询问了关于低危患者行择期开放式无网片腹股沟疝修补术（OIHRWOM）、开放式带网片腹股沟疝修补术（OIHRWM）或腹腔镜腹股沟疝修补术（LIHR）时的处方模式和当前证据知识的多项选择和自由文本答案。
共有 110 名 DoD 普通外科医生同意参与。分别有 58.6%、95%和 84.2%的外科医生始终在 OIHRWOM、OIHRWM 和 LIHR 中使用抗生素预防。分别有 37.9%、70.9%和 63.2%的外科医生认为抗生素预防可以降低 OIHRWOM、OIHRWM 和 LIHR 中的手术部位感染率。经验性开抗生素预防的最常见原因包括“我认为证据支持它”（72 个回答中的 27 个）、“我宁愿保守和安全”（72 个回答中的 15 个）和“我在遵循我的医院/部门的指南”（72 个回答中的 9 个）。分别有 11.8%、40.8%和 32.9%的外科医生认为当前的证据支持 OIHRWM、OIHRWOM 和 LIHR 中使用抗生素预防。分别有 50%、18.4%和 22.4%的外科医生认为当前的证据否定了 OIHRWM、OIHRWOM 和 LIHR 中使用抗生素预防。
调查结果表明，尽管有更多的观点认为抗生素预防对 IHR 没有意义或当前的证据不支持其使用，但大多数美国国防部的普通外科医生在 IHR 中仍经验性地开抗生素预防处方。
