Is antibiotic prophylaxis mandatory in laparoscopic incisional hernia repair? Data from the herniamed registry

INTERNATIONAL JOURNAL OF SURGERY

卷:58

Article

Kirchhoff, Philipp¹  Hoffmann, Henry^1,3  Koeckerling, Ferdinand²  Adolf, Daniela⁴  Bittner, Reinhard⁵  Staerkle, Ralph F.¹ 

[1] Univ Hosp Basel, Dept Surg, Clin Visceral Surg, Spitalstr 21, CH-4031 Basel, Switzerland

[2] Vivantes Hosp, Charite Med Sch, Dept Surg, Acad Teaching Hosp, Neue Bergstr 6, D-13585 Berlin, Germany

[3] Vivantes Hosp, Charite Med Sch, Ctr Minimally Invas Surg, Acad Teaching Hosp, Neue Bergstr 6, D-13585 Berlin, Germany

[4] StatConsult GmbH, Halberstadter Str 40 A, D-39112 Magdeburg, Germany

[5] Winghofer Med Hernia Ctr, Winghofer Str 42, D-72108 Rouenburg, Germany

关键词: Incisional hernia;    Surgical site infection;    Antibiotic prophylaxis;    Laparoscopic hernia repair;    Risk factors;   

DOI  :  10.1016/j.ijsu.2018.08.012

来源: Elsevier

【 摘 要 】

Background: Several meta-analyses showed that laparoscopic incisional hernia repair is associated with lower surgical site infection (SSI) rates compared to open repair. However, the efficiency of antibiotic prophylaxis (AP) in laparoscopic incisional hernia repair alone is unknown and needs evaluation. Due to increasing antimicrobial resistance, a major global health care problem, AP needs to be critically evaluated. The aim of this study was to investigate the impact of AP on the rate of SSI and complication-related reoperations in patients undergoing laparoscopic incisional hernia repair. Materials and methods: Prospectively documented data from the Herniamed Hernia Registry from 2009 to 2017 were retrospectively analysed. Multivariable analyses were used to study the influence of AP as well as further patient and surgery-related risk factors on SSI and complication-related reoperation rates. This was verified in a sensitivity analysis using propensity-score matching. Results: In the analysed time period 13'513 patients undergoing elective laparoscopic incisional hernia repair were recorded, of which 14.4% (n = 1949) did not receive AP. The overall SSI rate showed no significant difference when directly comparing patients with (0.74%) and without AP (0.97%; p = 0.262). In the multivariable analysis the presence of patient related risk factors (p = 0.015) and defect size > 10 cm (p = 0.035) significantly increased the rates of SSI and complication-related reoperations. The propensity-score matching analysis verified that SSI rates are not significantly different between the two groups (p = 0.265). Conclusions: In cases of laparoscopic incisional hernia repair in patients without risk factors and moderate hernia diameter (< 10 cm), routine administration of AP in laparoscopic incisional hernia repair does not seem to be justified.

【 授权许可】

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