Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience

Abstract

Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis. The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained.

Figure 1

Wound infection after thyroidectomy.

Figure 2

Wound oedema and erytema after thyroidectomy.

Figure 3

Wound oedema after thyroidectomy.

Figure 4

Comprehensive analysis of all wound complications after thyroidectomy.

Figure 5

Comprehensive analysis of all wound complications after thyroidectomy: patients in whom the drain was removed in the first post-operative day vs those in whom it was removed in the following days.

Figure 6

Comprehensive analysis of all wound complications after thyroidectomy in patients in whom the drain was removed in the first post-operative day: antibiotic prophylaxis vs no antibiotic prophylaxis.

Figure 7

Comprehensive analysis of all wound complications after thyroidectomy in patients in whom the drain was removed after the first post-operative day: antibiotic prophylaxis vs no antibiotic prophylaxis.