“Prospective study evaluating incidence of surgical site infection in thyroidectomy: Is antibiotic prophylaxis required?

Abstract

Objective: Occurrence of surgical site infection (SSI) is considered a rare occurrence in patients undergoing thyroidectomy. International guidelines do not recommend usage of antimicrobial prophylaxis (AP) for thyroid surgery and this study is aimed at finding whether such guidelines hold ground in a developing country like India. Study design: This prospective comparative study included 293 patients who underwent thyroidectomy at a single institution. Setting: The study was conducted in a tertiary referral hospital (Amrita institute of medical sciences, Kochi, Kerala, India) between 2017 - 2019. Methods: One group undergoing thyroidectomy received AP and other did not. Incidence of SSI was assessed in all patients during in-patient stay, 10th day and 30th day. Details of the data collected includes patient’s age, gender, co-morbidity, nutritional status, operative and drain duration, length of stay in the hospital. Results: Out of 293 patients, five cases of SSI were diagnosed in the group without AP (Four – superficial SSI and one - deep incisional SSI) and zero cases in the group with AP. Our study revealed an infection rate of 1.7 % in thyroid surgery. Comparing incidence of SSI in patients with and without AP, there was no statistically significant difference (p=0.152). In multivariate analysis, type 2 Diabetes Mellitus (p=0.016) and overweight/obesity (p=0.045) were identified as independent risk factors for SSI. Conclusion: Our results were found to be in synchronization with international guidelines and concluded that AP is not a necessary pre-operative preparation for all patients undergoing thyroidectomy but in a developing country like India multiple factors could predispose patients to SSI resulting in significant strain on the hospital and the patients’ financial resources. Patients with Type 2 Diabetes Mellitus and overweight/obese patients may be considered as high-risk patients in whom selective use of antimicrobial prophylaxis may be beneficial.