Preoperative antibiotic prophylaxis versus placebo in clean, nonprosthetic surgery at CHUK. Impact on surgical site infections and cost of care

Abstract

Introduction: surgical site infections represent the most frequent adverse event affecting the safety of surgical patient worldwide. Several preventive measures have been put in place including preoperative antibiotic prophylaxis. Their benefits are proved for clean-contaminated and contaminated wounds. However, there is lack of consensus on the use of antibiotic prophylaxis in clean surgery especially in area with high rate of surgical site infections. Objectives: this study aimed to determine the impact of preoperative antibiotic prophylaxis on SSI rate and cost of care in clean non-prophylactic surgeries at CHUK Methods: a double blind randomized controlled trial of patients undergoing clean, nonprosthetic elective surgical procedures at CHUK. With 1:1 allocation, one group was assigned for preoperative intravenous cefazolin (intervention group) within an hour of skin incision and the other group was assigned for a similar looking preparation of water for injection (control group). The primary outcome was the rate of surgical site infection at discharge and after 30 postoperative days. Results: 142 patients were recruited, 72 in intervention group and 70 in control group. The age range between 4 months to 85 years (mean age of 25.4; IQR: 39.75), and 65 (47.8 %) were pediatric (15 years and below); 97 were male and 44 female. 121 (85%) patients were ASA score 1 and 21 (15%) patients were ASA score 2. Thyroid, hernias and hydrocele accounted almost 2/3 of the procedures. The overall SSI rate within 30 postoperative days was 2.2% (3 patients) in which 2 patients were from control group and one from intervention group and the difference was not significant (P=0.559). Postoperative hypoxia was associated with increased risk of SSI (P<0.05) and being an adult patient was an independent factor for SSI in clean surgery. There was a total increment of hospital cost of 285,600 RFW (321USD) in intervention group compared to the control one. Conclusion: routine use of preoperative antibiotics should be discouraged as they do increase cost of care without an impact on SSI rate in patients undergoing with clean non-prosthetic surgeries.