Effect of Antibiotic Prophylaxis on Surgical Site Infection in Thyroid and Parathyroid Surgery: A Systematic Review and Meta-Analysis
Andrea Polistena,
Francesco Paolo Prete,
Stefano Avenia,
Giuseppe Cavallaro,
Giovanna Di Meo,
Alessandro Pasculli,
Fabio Rondelli,
Alessandro Sanguinetti,
Lucia Ilaria Sgaramella,
Nicola Avenia,
Mario Testini,
Angela Gurrado
Affiliations
Andrea Polistena
Oncologic and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Policlinico Umberto I, 00161 Roma, Italy
Francesco Paolo Prete
Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
Stefano Avenia
General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy
Giuseppe Cavallaro
Oncologic and Laparoscopic Surgery, Department of Surgery Pietro Valdoni, Sapienza University of Rome, Policlinico Umberto I, 00161 Roma, Italy
Giovanna Di Meo
Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
Alessandro Pasculli
Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
Fabio Rondelli
General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy
Alessandro Sanguinetti
General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy
Lucia Ilaria Sgaramella
Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
Nicola Avenia
General and Endocrine Surgery, School of Medical, University of Perugia, S. Maria University Hospital, 05100 Terni, Italy
Mario Testini
Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
Angela Gurrado
Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The purpose of this systematic review is analyzing whether the postoperative SSI rate in thyroid and parathyroid surgery is altered by the practice of AP. We searched Pubmed, Scopus, the Cochrane Library, and Web of Science (WOS) for studies comparing AP to no preoperative antibiotics up to October 2021. Data on the SSI rate was evaluated and summarized as relative risks (RR) with 95% confidence intervals (95% CI). Risk of bias of studies were assessed with standard methods. Nine studies (4 RCTs and 5 nRCTs), including 8710 participants, were eligible for quantitative analysis. A meta-analysis showed that the SSI rate was not significantly different between AP and no preoperative antibiotics (SSI rate: 0.6% in AP vs. 2.4% in control group; RR 0.69, 0.43–1.10 95% CI, p = 0.13, I2 = 0%). A sensitivity analysis and subgroup analysis on RCTs were consistent with the main findings. Evidence of low quality supports that AP in thyroid and parathyroid surgery produce similar SSI rates as to the absence of perioperative antibiotics.
