Prophylactic antibiotics at the time of elective cholecystectomy are effective in reducing the post-operative infective complications: a systematic review and meta-analysis

Background: The objective of this article is to evaluate the role of prophylactic antibiotics in preventing the infective complications in patients undergoing elective laparoscopic cholecystectomy (ELC).

Methods: A systematic review of the literature on the published randomized, controlled reporting the role of prophylactic antibiotics in preventing the infective complications in patients undergoing ELC was undertaken using the principles of meta-analysis.

Results: Twenty-five RCTs on 6,138 patients evaluating the infective complications in patients undergoing ELC were systematically analysed. There were 3,099 patients in antibiotics group and 3,039 patients in no-antibiotics group. The risk of surgical site infection (SSI) [odds ratio (OR), 0.75 (95% CI, 0.52-1.07), P=0.11], distant infection [OR, 0.66 (95% CI, 0.21-2.14), P=0.49] and residual abscess [OR, 0.93 (95% CI, 0.23-3.81), P=0.92] was lower in the antibiotics group but statistical significance was not reached. However, the risk of overall all type of infective complications was statistically lower [OR, 0.69 (95% CI, 0.50-0.95), P=0.02] in the antibiotics group. Subsequently, this was reflected into the reduced length of hospitalization [standardized mean difference (SMD), -0.32 (95% CI, -0.54--0.10), P=0.004] in the antibiotics group.

Conclusions: Use of prophylactic antibiotics at the time of induction in patients undergoing ELC has clinically proven advantage of reducing the post-operative infective complications.