Impact of extended prophylactic antibiotic administration on surgical site infections: A multicenter real-world data study.

Abstract

Purposes: Despite guideline recommendations to discontinue prophylactic antibiotics within 24 h postoperatively, extended prophylaxis is sometimes administered in clinical practice, particularly in digestive surgeries with a high risk of surgical site infections (SSI). This multicenter retrospective study evaluated the characteristics of patients receiving extended prophylaxis and its effectiveness in preventing SSI.

Methods: Clinical and administrative claims data from three hospitals were analyzed for patients undergoing elective esophageal, gastric, hepatic (with or without biliary reconstruction), pancreatic, colon, or rectal surgery between January 2021 and December 2023. The primary endpoint was SSI, defined as Clavien-Dindo grade ≥ 2 occurring within 30 days postoperatively. The incidence of SSI was compared between extended prophylaxis (continued on or after postoperative day 3) and standard prophylaxis.

Results: This study included 2,938 patients, of whom 936 received extended prophylaxis. Prolonged surgical time was significantly associated with extended prophylaxis across various types of surgery. Extended prophylaxis was not associated with a reduction in SSI in most procedures and was linked to a higher incidence of SSI in colon cancer patients.

Conclusion: Extended prophylaxis may not only be ineffective but also potentially harmful. These findings underscore the importance of adhering to evidence-based guidelines in the prevention of SSI.