Variation in prophylactic antibiotic use for laparoscopic cholecystectomy: need for better stewardship in pediatric surgery.

PURPOSE: The role of prophylactic antibiotics for elective laparoscopic cholecystectomy has been questioned over the last decade. Although gradually being discontinued in the adult population, the practice among pediatric surgeons remains unknown. Our aim was to investigate the use of perioperative antibiotics in children undergoing elective laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis and biliary dyskinesia.

METHODS

We retrospectively reviewed the Pediatric Health Information System (PHIS) database for 2015 and selected all patients 18years old or younger who underwent LC for cholelithiasis (without cholecystitis) or biliary dyskinesia. Demographic and hospital data were extracted as well as antibiotics administered and surgical complications.

RESULTS

A total of 1112 patients from 44 hospitals were identified with a median age of 15years (IQR 13-16years). Eight out of every 10 hospitals routinely give prophylactic antibiotics in more than 50% of patients. In 37 hospitals that performed more than 5 LC per year, 19 to 100% of patients were given antibiotics. No surgical complications were identified in those who did not get antibiotics.

CONCLUSION

There is significant inter-hospital variation in prophylactic antibiotic administration for elective LC in children. Perioperative antibiotic administration should be tracked as a quality metric in the current push for better stewardship.

LEVEL OF EVIDENCE: III.

TYPE OF STUDY: Retrospective.