Perioperative antibiotics for mild or moderate acute cholecystitis - A systematic review and meta-analysis.

BACKGROUND

The need for antibiotics in mild-moderate cholecystitis is not known. This systematic review and meta-analysis determines the impact of perioperative antibiotics on postoperative infectious complications in patients with mild-moderate acute cholecystitis undergoing acute cholecystectomy.

METHODS

Electronic searches were performed in EMBASE, Pubmed, and CENTRAL. Random effects meta-analyses were performed.

RESULTS

Meta-analysis of infectious complications with 9% (84/889) in intervention group, 12% (106/895) in control group, and no significant effects of antibiotics (8 studies, odds ratio (OR) = 0.78, 95% confidence interval (CI) = [0.58; 1.07], I2 = 0%). Surgical site infections with 5% (28/521) in intervention group, 8% (42/521) in control group, and no significant effects of antibiotics (4 studies, OR = 0.72, CI[0.38; 1.38], I2 = 26%). Length of stay and mortality without significant differences. Trial sequential analysis with futility thresholds reached.

CONCLUSION

Antibiotics in mild-moderate acute cholecystitis do not reduce postoperative infections. Current evidence supports omitting antibiotics in the otherwise healthy patients. Further studies of high-risk patients are needed.