Abstract
Background: Laparoscopic cholecystectomy (LC) is a minimally invasive surgical procedure performed for the removal of the gallbladder due to gall stones or other gallbladder complications. Surgical antimicrobial prophylaxis (SAP) is a common peri-operative intervention which involves administration of antimicrobial agents for the prevention of surgical site infections (SSI). The Canterbury District Health Board (CDHB) uses the Pink Book which outlines SAP guidelines for LC.
Aim: The aims for this study were to investigate the pattern of SAP use for LC procedures, determine SAP compliance for LC against the CDHB Pink Book, and evaluate appropriateness of SAP regimes for LC against the Therapeutic Guidelines of Australia.
Methodology and Methods: Using a quantitative methodology, a retrospective clinical records audit was conducted which investigated all publicly funded LC operations in Christchurch from the first six-months of 2020. A potential study population was identified by using ICD codes which generated an initial list of NHIs. Inclusion and exclusion criteria were applied to the identify to obtain the final study population. A combination of electronic and hardcopy clinical records were used to gather relevant data from the study population including demographic data, surgical data, and SAP data. Results: The final study population included 111 individuals, with 80% being female and the median age being 47 years. Individuals were identified across three hospital sites in Christchurch: Christchurch Hospital, St George's Hospital, and Southern Cross Hospital. Sixty-five individuals from the study population were administered a SAP regimen, 49 were administered an antimicrobial agent compliant with the Pink Book guidelines and 16 were administered a SAP regimen outside of the Pink Book guidelines. The remaining 46 individuals in the study population were not administered SAP. Based on the Pink Book, these individuals were not compliant with the guidelines. However, when assessed against the Therapeutic Guidelines of Australian surgical antimicrobial prophylaxis for biliary surgeries and the Australian National Antimicrobial Prescribing Survey for appropriateness, only 18 of the 65 individuals that received SAP were identified as requiring SAP, with the remaining 47 individuals not requiring SAP. Assessment for appropriateness of the no SAP regimens identified 37 individuals in whom this approach was appropriate and eight individuals who did not receive SAP inappropriately.
Conclusion: The data collected from the study population, including demographic data and surgical data, were consistent with findings from wider literature. The use of SAP for LC is increasingly being debated as to whether it is necessary for the prevention of SSI. Multiple studies have suggested that the incidence of SSI when comparing SAP and no SAP is not statistically significant, proposing that SAP does not provide any significant benefit over risks. However, several authors state that SAP should still be used if individuals have risk factors or comorbidities, including being over 70 years and having diabetes, that increase their risk of post-operative complications.