Antibiotic Prophylaxis for Elective Pediatric Laparoscopic Cholecystectomies

Infographic · Feb 2025 · 1 min read

In brief

NSQIP analysis of 3,959 low-risk pediatric laparoscopic cholecystectomy patients found that antibiotic prophylaxis reduced surgical site infections by 65%, challenging current SIS guidelines recommending against prophylaxis. Findings suggest pediatric-specific guidelines may be needed.

90% of low-risk pediatric lap chole patients received SAP despite SIS guidelines recommending against it in this population.
Patients without SAP had significantly higher SSI rates: superficial 2.1% vs 0.8%, organ space 0.8% vs 0.1% (p<0.05).
SAP reduced odds of any postoperative SSI by 65% (OR=0.35) after controlling for demographics in multivariable analysis.
No difference in C. diff colitis rates between SAP and no-SAP groups (0.1% vs 0.0%, p=1.0).
Current SIS guidelines may not apply to pediatric patients; reassessment needed given protective effect of prophylaxis.

Written by the GCMD Library team from the infographic.

Christine Rodhouse, Rachel Raymond, Dan Neal, Tyler J. Loftus, Faraz A. Khan, Ana R. Do, Janice A. Taylor, Philip A. Efron, Shawn D. Larson, Steven L. Raymond

Background: The Surgical Infection Society (SIS) guidelines recommend against the use of surgical antibiotic prophylaxis (SAP) for low-risk patients undergoing elective laparoscopic cholecystectomies.

Methods: Using National Surgical Quality Improvement Program (NSQIP) data, 5440 pediatric patients were identified who underwent laparoscopic cholecystectomy from 2021 to 2022. Patients who had immunodeficiency, active malignancy, American Society of Anesthesiologists (ASA) physical status classification 3–5, procedure indicated for infection, emergent procedure, received intravenous antibiotics before the prophylaxis window, or missing SAP data were excluded.

Results: 3959 patients were included in the analysis. Among these patients, 3570 (90.2 %) received SAP. Overall incidence of 30-day superficial incisional surgical site infection (SSI), deep incisional SSI, and organ space SSI were 0.9 %, 0.0 %, and 0.1 %, respectively. The incidence of superficial incisional SSI was significantly higher in the patients who did not receive SAP (SAP 0.8 %, no SAP 2.1 %; p = 0.024). The incidence of organ space SSI was also significantly higher in the patients who did not receive SAP (SAP 0.1 %, no SAP 0.8 %; p = 0.008). There was no difference in the incidence of C. diff colitis (SAP 0.1 %, no SAP 0.0 %; p = 1.000). Multivariable modeling, controlling for Hispanic ethnicity, age, and gender, demonstrated patients that received SAP were significantly less likely to have any postoperative SSI compared to patients who did not receive SAP (OR = 0.35).

Conclusion: Hospitals are not currently compliant with SIS guidelines regarding omission of antibiotic prophylaxis for low-risk patients undergoing elective laparoscopic cholecystectomies. The authors advocate for additional studies and reassessment of current guidelines for pediatric patients given the above findings.