Reducing prophylactic antibiotics use in laparoscopic cholecystectomy and liver resections

Abstract

Laparoscopic cholecystectomy and liver resections are commonly performed surgical procedures which require no or less (cefazolin only) antimicrobial prophylaxis respectively in light of recent evidence. To assess the validity of this data in the local context and increase compliance to such regimens, a multi-modal intervention including, changes to hospital antibiotic prophylaxis guidelines, departmental emphasis, information technology aids (involving the creation of order templates within our electronic medical system) and physical aids (in the form of cards given to junior staff) was implemented. Results comparing a 6-month preintervention period (January 2018 to June 2018) showed no significant increase in 30-day hospital readmission rates (P = 0.8, 0.7) despite a significant rise in compliance (P = 0.04, 0.03) in laparoscopic cholecystectomy (n = 371) and liver resections respectively (n = 193) compared to the 6-month intervention period (July 2018 to December 2018). Additionally, prescription behavior for liver resections was more varied than that of laparoscopic cholecystectomy likely due to the different anatomical considerations in the prior. In conclusion, removal of antibiotic prophylaxis in laparoscopic cholecystectomy and use of cefazolin only in liver resection is not associated with any significant increase in 30-day hospital readmission rates.