A New Gold Standard? Impact of Broad-spectrum Penicillin-based Antibiotic Prophylaxis on Outcome After Pancreatoduodenectomy - Results of a Systematic Review and Meta-analysis (PROSPERO CRD42024559197).
Julian C Harnoss, Darius Halm, Sophie Weber, Benedict Kinny-Köster, Max Heckler, Rosa Klotz, Eva Kalkum, Jonathan M Harnoss, Julian Musa, Pascal Probst, Christoph W Michalski, Martin Loos, Thomas Hank
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引用次数: 0
Abstract
Objective: This review evaluated whether broad-spectrum penicillin-based antibiotic prophylaxis (BS-AB) such as piperacillin-tazobactam might lead to better outcomes in pancreatoduodenectomy compared to standard care antibiotics, mainly cephalosporins (CE-AB).
Background: Pancreatoduodenectomy is commonly associated with high postoperative infectious complications contributing to increased morbidity, mortality and healthcare costs.
Methods: A systemic literature search (PubMed, EMBASE, Cochrane Library and Web of Science) was conducted to identify suitable RCTs and non-RCTs. After inclusion, the data were analyzed using a random-effects model with the Mantel-Haenszel model or inverse variance to calculate, odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI).
Results: One RCT and 11 non-RCTs were included with 12,469 patients (35,3% BS-AB, 64,7% CE-AB). Surgical site infections (SSI) were significantly lower after BS-AB when compared to CE-AB, (OR 0.53; CI [0.32-0.86]; P =0.01; I 2 =79%) as well as the occurrence of postoperative pancreatic fistula (POPF) (OR 0.62; CI [0.47-0.81]; P <0.01; I 2 =0%), days of hospitalization (MD-2.02; CI [-4.08-0.03]; P =0.05; I 2 =98%) and mortality (OR 0.56; CI [0.34-0.95]; P =0.03; I 2 =0%). Subgroup analyses of patients with preoperative biliary drainage demonstrated an even higher effect of BS-AB in reducing SSI (OR 0.45, CI [0.45-0.67]; P =0.01; I 2 =78%), POPF (OR 0.52; CI [0.36-0.75]; P <0.01; I 2 =0%) and mortality (OR 0.34; CI [0.15-0.76]; P <0.01; I 2 =0%).
Conclusion: BS-AB significantly reduces the risk of infectious complications and surgical outcomes in pancreatoduodenectomy compared to CE-AB, particularly in patients with preoperative biliary drainage. These findings support the use of BS-AB as a new gold standard for patients undergoing pancreatoduodenectomy.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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