The effect of prolonged antibiotics on postoperative complications for common bile duct stones: A post hoc analysis of an EAST multicenter study

Brett M. Tracy, Cameron W. Paterson, Denise M. Torres, Katelyn Young, Jonathan M. Saxe, Daniel P. Kinstedt, Martin D. Zielinski, Maraya Camazine, D. Dante Yeh, Rondi B. Gelbard

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Antimicrobial guidance for common bile duct (CBD) stones is limited. We sought to examine the effect of antibiotic duration on infectious complications in patients with choledocholithiasis and/or gallstone pancreatitis. METHODS We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019. We excluded patients with cholangitis and/or cholecystitis. Patients were divided into groups based on duration of antibiotics: Prophylactic (<24 hours) or prolonged (≥24 hours). We analyzed these two groups in the preoperative and postoperative periods. Outcomes included infectious complications, acute kidney injury (AKI), and hospital length of stay (LOS). RESULTS There were 755 patients in the cohort. Increasing age, CBD diameter, and a preoperative endoscopic retrograde cholangiopancreatography (odds ratio, 1.91; 95% confidence interval, 1.34-2.73; p < 0.001) significantly predicted prolonged preoperative antibiotic use. Increasing age, operative duration, and a postoperative endoscopic retrograde cholangiopancreatography (odds ratio, 4.8; 95% confidence interval, 1.85-13.65; p < 0.001) significantly predicted prolonged postoperative antibiotic use. Rates of infectious complications were similar between groups, but LOS was 2 days longer for patients receiving overall prolonged antibiotics (p < 0.0001). Patients with AKI received two more days of overall antibiotic therapy (p = 0.02) compared with those without AKI. CONCLUSION Rates of postoperative infectious complications were similar among patients treated with a prolonged or prophylactic course of antibiotics. Prolonged antibiotic use was associated with a longer LOS and AKI. LEVEL OF EVIDENCE Therapeutic, Level IV.

Original languageEnglish (US)
Pages (from-to)234-240
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume91
Issue number1
DOIs
StatePublished - 2021

Keywords

  • acute kidney injury
  • antibiotics
  • Common bile duct stones
  • length of stay
  • surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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