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Review
. 2012 Feb;55(1):27-32.
doi: 10.1503/cjs.018310.

Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty

Jian-Fang Li  1 , Dan-Dan Lai, Xiao-Dong Zhang, Ai-Min Zhang, Kuan-Xue Sun, Heng-Gui Luo, Zhen Yu
Affiliations
Review

Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty

Jian-Fang Li et al. Can J Surg. 2012 Feb.

Abstract
in English, French

Background: Previous reviews of the effectiveness of antibiotic prophylaxis for elective inguinal hernia repair were not conclusive owing to the limited number of patients enrolled in randomized controlled trials (RCTs). However, since new RCTs involving patients undergoing tention-free hernioplasty have been published in recent years, we performed a new meta-analysis to evaluate the effectiveness of antibiotic prophylaxisin the prevention of postoperative complications after this procedure.

Methods: We performed a meta-analysis of RCTs studying the use of antibiotic prophylaxis to prevent postoperative complications in patients undergoing tension-free hernioplasty.

Results: We included 6 RCTs conducted around the world in our analysis. Compared with the control condition, antibiotic prophylaxis was associated with a lower incidence of incision infection (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26-0.77, p = 0.004). There were no significant differences in risk for incision hematoma (OR 1.57, 95% CI 0.60-4.10, p = 0.35), respiratory infection (OR 1.00, 95% CI 0.17-5.79, p > 0.99) or urinary tract infection (OR 1.81, 95% CI 0.38-8.52, p = 0.45) between the 2 conditions.

Conclusion: Antibiotic prophylaxis use in patients undergoing tension-free hernioplasty decreases the rate of incision infection by 55%.

Contexte: Les études antérieures sur l’efficacité de la prophylaxie aux antibiotiques pour la réparation élective d’une hernie inguinale n’étaient pas concluantes à cause du nombre limité de patients inscrits aux essais contrôlés randomisés (ECR). Cependant, comme les résultats de nouveaux ECR mettant en cause des personnes qui ont subi une hernioplastie sans tension ont été publiés au cours des dernières années, nous avons procédé à une nouvelle méta-analyse pour évaluer l’efficacité de la prophylaxie aux antibiotiques dans la prévention des complications postopératoires.

Méthodes: Nous avons effectué une méta-analyse d’ECR portant sur l’utilisation de la prophylaxie aux antibiotiques pour prévenir les complications postopératoires chez tous les patients qui ont subi une hernioplastie sans tension.

Résultats: Nous avons inclus dans notre analyse 6 ECR effectués dans divers pays. Comparativement aux groupes témoins, on a établi un lien entre la prophylaxie aux antibiotiques et une incidence plus faible d’infection de l’incision (risque relatif [RR] 0,45, intervalle de confiance [IC] à 95 %, 0,26–0,77, p = 0,004). Il n’y avait pas de différences significatives au niveau du risque d’hématome à l’incision (RR 1,57, IC à 95 %, 0,60–4,10, p = 0,35), d’infection respiratoire (RR 1,00, IC à 95 %, 0,17–5,79, p > 0,99) ou d’infection urinaire (RR 1,81, IC à 95 %, 0,38–8,52, p = 0,45) entre les groupes de participants et les groupes témoins.

Conclusion: L’utilisation d’une prophylaxie aux antibiotiques chez les patients qui subissent une hernioplastie sans tension réduit de 55 % le taux d’infection de l’incision.

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Figures

Fig. 1
Fig. 1
Effect of antibiotic prophylaxis on incision infection in patients who have had tension-free hernioplasty. CI = confidence interval.
Fig. 2
Fig. 2
Sensitivity analysis by quality, excluding the study by Celdran and colleagues. CI = confidence interval.
Fig. 3
Fig. 3
Effect of antibiotic prophylaxis on secondary outcomes in patients who had tension-free hernioplasty. CI = confidence interval.
See this image and copyright information in PMC

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