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Antibiotic prophylaxis for hernia repair.

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Abstract

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Background

The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area.

Objectives

The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair.

Search methods

We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline using the following terms: #1 antibiotic* OR antimicrob* OR anti infecti* OR antiinfecti*; #2 prophyla* OR prevent*; #3 #1 AND #2; #4 clean AND (surgery OR tech* OR proced*); #5 herni*; #6 (wound infection) AND #4; #7 #3 AND (#4 or #5 or #6). National Research Register, ISI‐Web, DARE, Scirus, TRIPDATABASE, NHS EED, reference list of the included studies and web of clinical trials register (www.controlled‐trials.com and clinicaltrials.gov) were checked to identify further studies.

Selection criteria

Only randomised clinical trials were included.

Data collection and analysis

In the present review, we searched for eligible trials in October 2011. This revealed four new included trials, so seventeen trials are included in the meta‐analysis. Eleven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorrhaphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A fixed effects model was used in the analysis.

Main results

The total number of patients included was 7843 (prophylaxis group: 4703, control group: 3140). Overall infection rates were 3.1% and 4.5% in the prophylaxis and control groups, respectively (OR 0.64, 95% CI 0.50 ‐ 0.82).
The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 ‐ 1.00).
The subgroup of patients with hernioplasty had infection rates of 2.4% and 4.2% in the prophylaxis and control groups, respectively (OR 0.56, 95% CI 0.38 ‐ 0.81).

Authors' conclusions

Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

Administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended.

The use of antibiotic prophylaxis for elective hernia repair is currently a controversial issue. Although elective hernia repair is considered a clean procedure, the rate of postoperative wound infection in many countries exceeds the one expected for clean surgery, increasing discomfort in patients and health care expenses. In addition, antibiotics administration is not exempt of potential risks.
Controlled clinical trials on the use of antibiotic prophylaxis for hernia repair are scarce, the number of patients studied is low and the results are diverse. Based on the results of this meta‐analysis of randomised clinical trials, administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended when high rates of wound infection are observed.