FTP6.13 Do prophylactic antibiotics on general anaesthetic induction improve surgical site and intra-abdominal infection post emergency laparoscopic cholecystectomy?

Abstract

Abstract Background The role of prophylactic antibiotics in reducing surgical site infection (SSI) and intra-abdominal infection rates in emergency laparoscopic cholecystectomy remains controversial. New antimicrobial Trust guidelines at our unit introduced in May 2022 stated that all emergency “hot” laparoscopic cholecystectomies should receive single dose of IV antibiotics on general anaesthetic induction. We aim to assess whether SSI and intra-abdominal infection rates have improved since introducing these new guidelines. Methods Retrospective study comparing SSI and intra-abdominal infection rates within 30 days of all emergency laparoscopic cholecystectomy cases between February and April 2022 (before new guidelines), to those between August to October 2022 (post new guidelines). Results Total of 56 emergency “hot” laparoscopic cholecystectomy cases prior to, and 44 cases after introduction of new guidelines. 91% cases received IV antibiotics on induction post new guidelines, compared to 35% prior to new guidelines (P=0.038). Proportion of patients who continued with antibiotics post-surgery between 2 cohorts was not statistically significant (P=0.69). There was no statistically significant improvement in overall SSI rates post introduction of new guidelines (P=0.61). Skin closure method (P=0.044) and operating time (P=0.031) were statistically significant in contributing to SSI. There was further no statistically significant difference in rate of intra-abdominal infection post introduction of new guidelines (P=0.83). Conclusion Prophylactic antibiotics at induction do not appear to improve either SSI or intra-abdominal infection rates post emergency lap cholecystectomy cases. Further evaluation is needed over a longer study period, however, in order to ascertain whether these guidelines should be altered for future practise.