Extended antibiotic therapy versus placebo after laparoscopic cholecystectomy for mild and moderate acute calculous cholecystitis: A randomized double-blind clinical trial

Santibañes, Martín de; Glinka, Juan; Pelegrini, Pablo; Alvarez, Fernando A.; Elizondo, Cristina; Giunta, Diego; Barcán, Laura; Simoncini, Lionel; Domínguez, Nora; Ardiles, Victoria; Mazza, Oscar; Clariá, Rodrigo Sanchez; Santibañés, Eduardo de; Pekolj, Juan

doi:10.1016/j.surg.2018.01.014

Cited by 19 publications

(22 citation statements)

References 31 publications

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“…Searches of electronic databases identified 399 articles of which 4 studies were selected for this review. These included 4 RCTs, 11-14 enrolling a total of 953 patients. Overall, 473 patients were included in the extended antibiotic group and 480 patients were included in the no antibiotic group.…”

Section: Resultsmentioning

confidence: 99%

“…The summary and results of methodological quality assessment of the 4 RCTs 11-14 are demonstrated graphically in Figure 2.…”

Section: Resultsmentioning

confidence: 99%

“…Postoperative morbidity was reported in 4 studies, 11-14 enrolling 953 patients. There was no difference in the risk of postoperative morbidity between the 2 groups (OR = 0.93, 95% = CI = 0.66 to 1.32, P = .70).…”

Section: Resultsmentioning

confidence: 99%

“…Noninfectious complications were reported in 4 studies, 11-14 enrolling 953 patients. There was no difference in the risk of noninfectious complications between the 2 groups (OR = 0.85, 95% CI = 0.49 to 1.48, P = .57).…”

Section: Resultsmentioning

confidence: 99%

“…We performed a systematic review and meta-analysis to compare the outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. We identified 4 RCTs 11-14 enrolling a total of 953 patients. The results of the analyses showed that there was no difference between the extended postoperative antibiotic therapy and no postoperative antibiotic therapy in terms of postoperative infectious or noninfectious outcomes in patients with mild or moderate acute calculous cholecystitis undergoing emergency cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

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Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis

2019

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Objectives. To compare the outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Methods. We performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials comparing outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative infectious complications and surgical site infections were primary outcome measures. The secondary outcome measures included postoperative morbidity, postoperative noninfectious complications, urinary tract infections, pneumonia, length of hospital stay, postoperative mortality, and need for readmission. Random or fixed effects modeling was applied to calculate pooled outcome data. Results. Four randomized controlled trials enrolling 953 patients were identified. The included populations in the extended antibiotic group and no antibiotic group were comparable in terms of baseline characteristics. There was no difference between the 2 groups in terms of postoperative infectious complications (odds ratio [OR] =0.94, P = .79), surgical site infections (OR = 1.13, P = .72), postoperative morbidity (OR = 0.93, P = .70), postoperative noninfectious complications (OR = 0.85, P = .57), urinary tract infections (OR = 0.69, P = .55), pneumonia (OR = 0.33, P = .14), length of hospital stay (mean difference = 0.78, P = .25), postoperative mortality (risk difference = −0.00, P = .65), and need for readmission (OR = 0.87, P = .70). Conclusions. Our results suggest that extended postoperative antibiotic therapy does not improve postoperative infectious or noninfectious outcomes in patients with mild or moderate acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative antibiotics should not be routinely used and should be preserved only for selected cases.

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Section: Resultsmentioning

confidence: 99%

“…The summary and results of methodological quality assessment of the 4 RCTs 11-14 are demonstrated graphically in Figure 2.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis

2019

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Scientific surgery

2018

British Journal of Surgery

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Scientific surgery Devereaux PJ, Duceppe E, Guyatt G, Tandon V, Rodseth R, Biccard BM et al. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial. Lancet 2018; 391: 2325-2334. Some 1754 patients with raised troponin levels after surgery, indicating myocardial injury, were included. Major adverse vascular events occurred in 11 per cent on dabigatran and 15 per cent on placebo; hazard ratio 0⋅72, 95 per cent c.i. 0⋅55 to 0⋅93, P = 0⋅0115. Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Miserez M, Muysoms FE. Meta-analysis on materials and techniques for laparotomy closure: The MATCH Review. World J Surg 2018; 42:1666-1678. Twenty-three RCTs were included. There was no high-quality evidence that any particular suture material or technique was best. If slowly absorbable sutures were used, small bites were more effective at reducing the risk of incisional hernia than large bites: odds ratio 0⋅41, 95 per cent c.i. 0⋅19 to 0⋅86.

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Clinical significance of preoperative antibiotic use in mild to moderate acute inflammatory gallbladder disease: A randomized controlled trial

Park

Choi

You

et al. 2022

J Hepato Biliary Pancreat

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Background: Many patients receive empirical antibiotics for the prevention of postoperative infectious complications following cholecystectomy due to acute cholecystitis (AC). The purpose of this study was to investigate the clinical significance of preoperative antibiotics in mild to moderate AC patients undergoing emergency laparoscopic cholecystectomy.Methods: This was a double-blind, placebo-controlled, randomized study.Patients with AC eligible for emergency laparoscopic cholecystectomy were randomly assigned to an antibiotic or a placebo group. Clinical outcomes including infectious complications were reviewed.Results: An imputed per-protocol analysis of 234 patients showed that the postoperative infection rate was 8.6% (10 of 116 patients) in the antibiotic group and 7.6% (9 of 118 patients) in the placebo group (absolute difference, 1%; 95% CI: −8.1% to 6.1%; P = .815). Based on a noninferiority margin of 10%, the lack of preoperative antibiotic treatment was not associated with worse clinical outcomes than antibiotic treatment. Surgical site infection was the most common complication among the infectious complications, and there was no significant difference between the two groups (7.8% in the antibiotic group vs 7.6%, in the placebo group, P = .53). Conclusions:The absence of prophylactic antibiotics has no significant impact on the incidence of infectious complications in mild to moderated AC.

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Extended antibiotic therapy versus placebo after laparoscopic cholecystectomy for mild and moderate acute calculous cholecystitis: A randomized double-blind clinical trial

Cited by 19 publications

References 31 publications

Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis

Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis

Scientific surgery

Clinical significance of preoperative antibiotic use in mild to moderate acute inflammatory gallbladder disease: A randomized controlled trial

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