Preoperative Antibiotics for Dialysis Access Surgery: Are They Necessary?

Abstract

Current guidelines recommend preoperative antibiotics in all vascular surgery cases. However, we hypothesize that patients undergoing arteriovenous fistula (AVF) and arteriovenous graft (AVG) creation have low rates of postoperative surgical site infection (SSI) and that preoperative antibiotic prophylaxis in these patients may not be necessary. This is a retrospective review of all patients who underwent AVF and AVG creation from November 2014 through July of 2016 at a single institution. At our institution, preoperative antibiotic use is surgeon dependent. Patients who received preoperative antibiotics were compared with those who did not. The primary outcome measured was the development of postoperative SSI. There were 304 patients identified and 294 patients with 30day postoperative follow-up. Of the 294 patients, 23 (7.8%) received an AVG, and 271 (92.2%) received an AVF. There were 244 (83%) patients who received preoperative antibiotics and 50 (17%) who did not. Overall, there were 2 (0.68%) SSIs identified. Both patients with postoperative SSI underwent AVF creation and received preoperative antibiotics. There was no statistically significant difference in SSI rate between antibiotic and nonantibiotic groups (P=1.0), and no difference when comparing patients that received AVG (0%) and AVF (0.73%) (P=1.0). The rate for postoperative SSI following hemodialysis access surgery is very low both for patients undergoing AVF and AVG. Furthermore, there was no difference in SSI rate between antibiotic and nonantibiotic groups. Given these findings, we conclude that preoperative antibiotics for AVF creation may not be necessary.