J Endocr Surg.  2017 Dec;17(4):160-167. 10.16956/jes.2017.17.4.160.

Perioperative Antibiotic Prophylaxis May Not Be Required Routinely in Thyroid Surgery

• Lee KB
• Kim SY
• Kim SM
• Chang HJ
• Kim BW
• Lee Y
• Chang HS
• Park CS
• Lim CY

• KMID: 2397993
• DOI: http://doi.org/10.16956/jes.2017.17.4.160

Abstract

PURPOSE
Although perioperative antibiotic prophylaxis is used to prevent surgical site infection (SSI), thyroid surgery is classified as a clean surgical procedure and routine use of perioperative antibiotic prophylaxis is not recommend. The purpose of this study is to evaluate the therapeutic benefits of using perioperative antibiotic prophylaxis in thyroid surgery.
METHODS
We evaluated medical records of 1,895 patients who underwent thyroid surgery between January 2013 and December 2013. We divided 2 groups with or without perioperative antibiotic prophylaxis. Clinical factors including sex, age, body mass index (BMI), and comorbidity and surgical factors for SSI were analyzed.
RESULTS
The male to female ratio was 1:3.3, the average age was 43 (14-82) years old. The numbers of groups without and with antibiotic prophylaxis were 593 and 1,303. Thirty-seven cases (2.0%) of postoperative complications were observed including chyle leakage, SSI, and nerve injury. The SSI was occurred in 10 patients (0.5%). Clinical factors with SSI were analyzed and there was no statistical significance between 2 groups.
CONCLUSION
In thyroid surgery, perioperative antibiotic prophylaxis may not be required routinely once the surgical procedure underwent with aseptic condition and the patients care was performed appropriately.

Keyword

Thyroidectomy; Anti-bacterial agents; Surgical wound infection

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis*
Body Mass Index
Chyle
Comorbidity
Female
Humans
Male
Medical Records
Postoperative Complications
Surgical Wound Infection
Thyroid Gland*
Thyroidectomy
Anti-Bacterial Agents

Reference

1. Kaye KS, Schmit K, Pieper C, Sloane R, Caughlan KF, Sexton DJ, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis. 2005; 191:1056–1062.

2. Garner JS. The CDC Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1993; 21:160–162.

3. Moro ML, Carrieri MP, Tozzi AE, Lana S, Greco D. Risk factors for surgical wound infections in clean surgery: a multicenter study. Italian PRINOS Study Group. Ann Ital Chir. 1996; 67:13–19.

4. Bures C, Klatte T, Gilhofer M, Behnke M, Breier AC, Neuhold N, et al. A prospective study on surgical-site infections in thyroid operation. Surgery. 2014; 155:675–681.

5. Leaper DJ, Edmiston CE. World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect. 2017; 95:135–136.

6. Qin Q, Li H, Wang LB, Li AH, Chen LJ, Lu Q. Thyroid surgery without antibiotic prophylaxis: experiences with 1,030 patients from a teaching hospital in China. World J Surg. 2014; 38:878–881.

7. Khuri SF, Daley J, Henderson W, Barbour G, Lowry P, Irvin G, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995; 180:519–531.

8. Dionigi G, Rovera F, Boni L, Dionigi R. Surveillance of surgical site infections after thyroidectomy in a one-day surgery setting. Int J Surg. 2008; 6:Suppl 1. S13–S15.

9. Association of Operating Room Nurses. Recommended practices for skin preparation of patients. AORN J. 2002; 75:184–187.

10. Hardy RG, Forsythe JL. Uncovering a rare but critical complication following thyroid surgery: an audit across the UK and Ireland. Thyroid. 2007; 17:63–65.

11. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004; 28:271–276.

12. Xiao QL. A comparison study on the application of plasmid profile analysis, phage typing and antimicrobial susceptibility testing to the epidemiological investigation of typhoid. Zhonghua Liu Xing Bing Xue Za Zhi. 1987; 8:272–275.

13. Gentile I, Rosato L, Avenia N, Testini M, D'Ajello M, Antonino A, et al. Do Italian surgeons use antibiotic prophylaxis in thyroid surgery? Results from a national study (UEC--Italian Endocrine Surgery Units Association). Ann Ital Chir. 2014; 85:33–37.

14. Browning AC, Alibhai A, McIntosh RS, Rotchford AP, Bhan A, Amoaku WM. Effect of diabetes mellitus and hyperglycemia on the proliferation of human Tenon's capsule fibroblasts: implications for wound healing after glaucoma drainage surgery. Wound Repair Regen. 2005; 13:295–302.

15. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997; 63:356–361.

16. Kaye KS, Sloane R, Sexton DJ, Schmader KA. Risk factors for surgical site infections in older people. J Am Geriatr Soc. 2006; 54:391–396.

17. Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008; 393:667–673.

18. Weber WP, Marti WR, Zwahlen M, Misteli H, Rosenthal R, Reck S, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg. 2008; 247:918–926.

19. Hernandez K, Ramos E, Seas C, Henostroza G, Gotuzzo E. Incidence of and risk factors for surgical-site infections in a Peruvian hospital. Infect Control Hosp Epidemiol. 2005; 26:473–477.

20. Dougherty SH, Simmons RL. The biology and practice of surgical drains. Part II. Curr Probl Surg. 1992; 29:633–730.

21. Samraj K, Gurusamy KS. Wound drains following thyroid surgery. Cochrane Database Syst Rev. 2007; CD006099.

22. Promberger R, Ott J, Kober F, Koppitsch C, Seemann R, Freissmuth M, et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg. 2012; 99:373–379.

23. Gil-Egea MJ, Pi-Sunyer MT, Verdaguer A, Sanz F, Sitges-Serra A, Eleizegui LT. Surgical wound infections: prospective study of 4,468 clean wounds. Infect Control. 1987; 8:277–280.

24. Nagachinta T, Stephens M, Reitz B, Polk BF. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis. 1987; 156:967–973.

25. Ellis LM, Copeland EM 3rd, Souba WW. Perioperative nutritional support. Surg Clin North Am. 1991; 71:493–507.