Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey

Abstract

PurposeEvidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent.MethodsSurgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of England on their practices and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair. Local prophylaxis guidelines for the participating hospital sites were also determined.ResultsThe study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons, a 93 % response rate. Overall, a large majority of hospital guidelines (22/28) and surgeons’ personal beliefs (192/229, 84 %) supported the use of single-dose pre-operative intravenous antibiotic prophylaxis in inguinal hernia repair, although there was considerable variation in the regimens in use. The most widely used regimen was intravenous co-amoxiclav (1.2 g). Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure, although many incorrectly believed that they were following these.ConclusionIn the south-east of England, there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure. It is therefore likely to be extremely difficult to conduct further randomised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure.

Antibiotic prophylaxis audit and questionnaire study: Traffic Light Poster improves adherence to protocol in gastrointestinal surgery

“…73% of the clean procedures audited received antibiotics incorrectly and the questionnaire further depicted the general attitude that procedures such as inguinal hernia repair should receive antibiotics. This practice is similar to other studies where surgeons give AP in clean surgery [22,23]. There is ambiguity in the literature with some papers advocating antibiotics in clean procedures [24,25] and others not [26,27].…”

A national trainee-led audit of inguinal hernia repair in Scotland

“…Despite this, prophylactic antibiotics were administered to 18 % of patients in this study. This is surprising given SIGN guidance, but not entirely out of keeping with practises in other parts of the UK, as a recent survey of 229 surgeons in the South East of England has shown that 79 % of hospital guidelines and 84 % of surgeons supported the use of antibiotic prophylaxis in inguinal hernia surgery [18]. The overall use of prophylactic antibiotics in inguinal hernia surgery in Scotland has reduced from its previous level of 71 % in 1998/9 so it appears that SIGN guidance has made an impact [11].…”

Antibiotic prophylaxis in open inguinal hernia repair: a literature review and summary of current knowledge.

“…those without risk factors for SSI). They justify their approach by the presence of an implant, despite the lack of sufficient clinical evidence to support this course of action [21]. …”

“…They base this opinion on their own beliefs and experience. Furthermore, 22 out of 28 hospitals interrogated in this region include antibiotic prophylaxis in their guidelines [21]. …”