Cefazolin not linked to fewer infections after laparoscopic adnexal surgery

A multicenter retrospective cohort study in Japan compared 30-day surgical site infections (SSIs) among 1,678 patients undergoing laparoscopic surgery for benign adnexal conditions. SSI rates were similar with and without pre-incision cefazolin, but the low number of infections limits certainty.

SSI rates were similar with and without cefazolin.
Only 19 infections occurred across the cohort.
Longer operations were associated with higher SSI odds.
Retrospective design limits conclusions about prophylaxis.

Researchers analyzed prospectively maintained data from Osaka University and six affiliated hospitals for patients who underwent laparoscopic adnexal surgery for benign conditions from 2020 to 2023. Of 1,865 patients assessed, 1,678 were included: 1,415 received pre-incision cefazolin and 263 received no prophylactic antibiotic, according to each hospital’s policy. The primary outcome was CDC-classified SSI within 30 days. The investigators used inverse probability of treatment weighting to adjust for selected patient characteristics and logistic regression to assess risk factors.

SSI occurred in 16 patients given cefazolin (1.1%) and three patients without prophylaxis (1.1%). After weighting, rates were 1.1% and 1.2%, respectively (p=0.915). Operative time of at least 120 minutes was associated with SSI (adjusted odds ratio 3.54, 95% CI 1.41–8.85). In a supplementary ovarian cystectomy analysis, uterine manipulator use was also associated with infection (adjusted odds ratio 4.03, 95% CI 1.26–12.90).

The findings do not demonstrate a reduction in SSI with routine cefazolin, but the study was retrospective, antibiotic use was determined by hospital policy, and only 19 SSIs occurred. Residual confounding and imprecise risk estimates remain possible; the authors call for further evaluation of selective prophylaxis.

In practice

For patients undergoing clean laparoscopic adnexal surgery for benign conditions, this Japanese retrospective cohort found no observed reduction in 30-day SSI with routine pre-incision cefazolin: weighted rates were 1.1% with prophylaxis and 1.2% without it. These data do not establish that withholding prophylaxis is equivalent or safe, because only 19 infections occurred, treatment was assigned by institutional policy, and residual confounding is possible. The findings alone do not support changing local prophylaxis practice; further evidence is needed.

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Source

Surgical Endoscopy: Are prophylactic antibiotics routinely necessary in laparoscopic adnexal surgery? A multicenter cohort study ↗

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