Abstract
Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The purpose of this systematic review is analyzing whether the postoperative SSI rate in thyroid and parathyroid surgery is altered by the practice of AP. We searched Pubmed, Scopus, the Cochrane Library, and Web of Science (WOS) for studies comparing AP to no preoperative antibiotics up to October 2021. Data on the SSI rate was evaluated and summarized as relative risks (RR) with 95% confidence intervals (95% CI). Risk of bias of studies were assessed with standard methods. Nine studies (4 RCTs and 5 nRCTs), including 8710 participants, were eligible for quantitative analysis. A meta-analysis showed that the SSI rate was not significantly different between AP and no preoperative antibiotics (SSI rate: 0.6% in AP vs. 2.4% in control group; RR 0.69, 0.43–1.10 95% CI, p = 0.13, I2 = 0%). A sensitivity analysis and subgroup analysis on RCTs were consistent with the main findings. Evidence of low quality supports that AP in thyroid and parathyroid surgery produce similar SSI rates as to the absence of perioperative antibiotics.
Highlights
Introduction iationsThyroid and parathyroid surgery are considered clean head and neck procedures that have no contact with the upper aerodigestive tract [1].With adequate sterilization and advanced operating rooms, postoperative infections are uncommon, and the reported incidence of surgical site infection (SSI) after thyroid surgery is low, ranging from 0.09% to 2.9 [2,3,4,5].Antimicrobial prophylaxis (AP) was introduced to prevent SSI or an infection related to the operative procedure, which occurs at or near the surgical incision within a30-day period [1]
Many centers report a low incidence of SSIs without the routine use of preoperative antibiotic prophylaxis (AP) [2,21], while international guidelines do not suggest routine AP in thyroid and parathyroid surgery [6,8]; but clinical evidence supporting these guidelines for thyroid surgeries is often limited
Antibiotic prophylaxis is not associated with the significant prevention of SSI in clean thyroid and parathyroid surgery
Summary
Introduction iationsThyroid and parathyroid surgery are considered clean head and neck procedures that have no contact with the upper aerodigestive tract (trachea, larynx, pharynx, or esophagus) [1].With adequate sterilization and advanced operating rooms, postoperative infections are uncommon, and the reported incidence of surgical site infection (SSI) after thyroid surgery is low, ranging from 0.09% to 2.9 [2,3,4,5].Antimicrobial prophylaxis (AP) was introduced to prevent SSI or an infection related to the operative procedure, which occurs at or near the surgical incision within a30-day period [1]. Thyroid and parathyroid surgery are considered clean head and neck procedures that have no contact with the upper aerodigestive tract (trachea, larynx, pharynx, or esophagus) [1]. With adequate sterilization and advanced operating rooms, postoperative infections are uncommon, and the reported incidence of surgical site infection (SSI) after thyroid surgery is low, ranging from 0.09% to 2.9 [2,3,4,5]. Antimicrobial prophylaxis (AP) was introduced to prevent SSI or an infection related to the operative procedure, which occurs at or near the surgical incision within a. SSI determined a prolonged hospital stay and an increased cost for the health system.
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