Ohashi, M., Saka, M., Katayama, H., Okinaka, K., Morita, S., Fukagawa, T., & Katai, H. (2015). A prospective cohort study to evaluate the feasibility of intraoperative antimicrobial prophylaxis in open gastrectomy for gastric cancer. Surgical Infections, 16, 833–839. 

DOI Link

Study Purpose

To evaluate the feasibility of intraoperative antimicrobial prophylaxis compared to conventional prophylaxis in patients undergoing elective open gastrectomy

Intervention Characteristics/Basic Study Process

Procedures for prophylaxis were conducted in two stages during six months. In the first stage, patients received four IV doses of cebazolin 1 g at 12-hour intervals beginning 30 minutes before surgery. In the second cohort, patients received the same agent at three-hour intervals beginning 30 minutes before surgery until the end of surgery. Perioperative care was conducted in a standard approach in both cohorts.

Sample Characteristics

  • N = 423   
  • MEAN AGE = 63.5 years
  • AGE RANGE = 27–88 years
  • MALES: 65.2%, FEMALES: 34.8%
  • CURRENT TREATMENT: Other
  • KEY DISEASE CHARACTERISTICS: All were undergoing gastrectomy for gastric cancer. Ninety-eight percent had a ASA score of 1 or 2.
  • OTHER KEY SAMPLE CHARACTERISTICS: Median operation time was four hours.

Setting

  • SITE: Single site   
  • SETTING TYPE: Inpatient    
  • LOCATION: Japan

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Cohort comparison—prospective

Measurement Instruments/Methods

The definition of surgical site infection (SSI) was based on the Centers for Disease Control and Prevention surveillance system.

Results

The overall SSI rate was 9.2%, and all were treated successfully with antibiotics. No statistically significant difference existed between cohorts.

Conclusions

Provision of antimicrobial prophylaxis immediately before and during the operative procedure appears to be feasible and sufficient for the prevention of SSI in patients undergoing gastrectomy.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)

 

Nursing Implications

Provision of antibiotic prophylaxis to reduce SSI 30 minutes before and during the surgical procedure may be sufficient. This study is limited by its design. Additional research is needed to determine the most effective timing and duration of antibiotic prophylaxis for SSI prevention in patients undergoing various types of surgical procedures.