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Abstract：
BACKGROUND: Emergency cholecystectomy is the mainstay in treating acute cholecystitis (AC). In actual practice, perioperative prophylactic antibiotics are used to prevent postoperative infectious complications (PIC), but their effectiveness lacks evidence. We aim to investigate the efficacy of prophylactic antibiotics in emergency cholecystectomy.
METHODS: We searched PubMed, Embase, Cochrane CENTRAL, Web of Science (WOS), and Scopus up to June 14, 2023. We included randomized controlled trials (RCTs) that involved patients diagnosed with mild to moderate AC according to Tokyo guidelines who were undergoing emergency cholecystectomy and were administered preoperative and/or postoperative antibiotics as an intervention group and compared to a placebo group. For dichotomous data, we applied the risk ratio (RR) and the 95% confidence interval (CI), while for continuous data, we used the mean difference (MD) and 95% CI.
RESULTS: We included seven RCTs encompassing a collective sample size of 1747 patients. Our analysis showed no significant differences regarding total PIC (RR = 0.84 with 95% CI (0.63, 1.12), P = 0.23), surgical site infection (RR = 0.79 with 95% CI (0.56, 1.12), P = 0.19), distant infections (RR = 1.01 with 95% CI (0.55, 1.88), P = 0.97), non-infectious complications (RR = 0.84 with 95% CI (0.64, 1.11), P = 0.22), mortality (RR = 0.34 with 95% CI (0.04, 3.23), P = 0.35), and readmission (RR = 0.69 with 95% CI (0.43, 1.11), P = 0.13).
CONCLUSIONS: Perioperative antibiotics in patients with mild to moderate acute cholecystitis did not show a significant reduction of postoperative infectious complications after emergency cholecystectomy. (PROSPERO registration number: CRD42023438755).
METHODS: We searched PubMed, Embase, Cochrane CENTRAL, Web of Science (WOS), and Scopus up to June 14, 2023. We included randomized controlled trials (RCTs) that involved patients diagnosed with mild to moderate AC according to Tokyo guidelines who were undergoing emergency cholecystectomy and were administered preoperative and/or postoperative antibiotics as an intervention group and compared to a placebo group. For dichotomous data, we applied the risk ratio (RR) and the 95% confidence interval (CI), while for continuous data, we used the mean difference (MD) and 95% CI.
RESULTS: We included seven RCTs encompassing a collective sample size of 1747 patients. Our analysis showed no significant differences regarding total PIC (RR = 0.84 with 95% CI (0.63, 1.12), P = 0.23), surgical site infection (RR = 0.79 with 95% CI (0.56, 1.12), P = 0.19), distant infections (RR = 1.01 with 95% CI (0.55, 1.88), P = 0.97), non-infectious complications (RR = 0.84 with 95% CI (0.64, 1.11), P = 0.22), mortality (RR = 0.34 with 95% CI (0.04, 3.23), P = 0.35), and readmission (RR = 0.69 with 95% CI (0.43, 1.11), P = 0.13).
CONCLUSIONS: Perioperative antibiotics in patients with mild to moderate acute cholecystitis did not show a significant reduction of postoperative infectious complications after emergency cholecystectomy. (PROSPERO registration number: CRD42023438755).
摘要：
背景：紧急胆囊切除术是治疗急性胆囊炎（AC）的主要手段。在实际的实践中,围手术期预防性抗生素用于预防术后感染并发症（PIC），但其有效性缺乏证据.我们的目的是探讨预防性抗生素在急诊胆囊切除术中的疗效。
方法：我们搜索了PubMed，Embase,科克伦中部,WebofScience(WOS),和Scopus至2023年6月14日。我们纳入了随机对照试验（RCT），该试验涉及根据东京指南诊断为轻度至中度AC的患者，这些患者正在接受紧急胆囊切除术，并在术前和/或术后给予抗生素作为干预组，并与安慰剂组进行比较。对于二分数据，我们应用了风险比(RR)和95%置信区间(CI)，而对于连续数据，我们使用均差(MD)和95%CI。
结果：我们纳入了7个RCTs，包含1747例患者的总体样本量。我们的分析显示总PIC没有显著差异(RR=0.84，95%CI(0.63，1.12)，P=0.23),手术部位感染(RR=0.79，95%CI(0.56，1.12)，P=0.19),远处感染（RR=1.01，95%CI（0.55，1.88），P=0.97),非感染性并发症(RR=0.84，95%CI(0.64，1.11)，P=0.22),死亡率(RR=0.34，95%CI(0.04，3.23)，P=0.35),和再入院(RR=0.69，95%CI(0.43，1.11)，P=0.13）。
结论：轻中度急性胆囊炎患者围手术期使用抗生素对急诊胆囊切除术后术后感染并发症没有明显的减少。（PROSPERO注册号：CRD42023438755）。
方法：我们搜索了PubMed，Embase,科克伦中部,WebofScience(WOS),和Scopus至2023年6月14日。我们纳入了随机对照试验（RCT），该试验涉及根据东京指南诊断为轻度至中度AC的患者，这些患者正在接受紧急胆囊切除术，并在术前和/或术后给予抗生素作为干预组，并与安慰剂组进行比较。对于二分数据，我们应用了风险比(RR)和95%置信区间(CI)，而对于连续数据，我们使用均差(MD)和95%CI。
结果：我们纳入了7个RCTs，包含1747例患者的总体样本量。我们的分析显示总PIC没有显著差异(RR=0.84，95%CI(0.63，1.12)，P=0.23),手术部位感染(RR=0.79，95%CI(0.56，1.12)，P=0.19),远处感染（RR=1.01，95%CI（0.55，1.88），P=0.97),非感染性并发症(RR=0.84，95%CI(0.64，1.11)，P=0.22),死亡率(RR=0.34，95%CI(0.04，3.23)，P=0.35),和再入院(RR=0.69，95%CI(0.43，1.11)，P=0.13）。
结论：轻中度急性胆囊炎患者围手术期使用抗生素对急诊胆囊切除术后术后感染并发症没有明显的减少。（PROSPERO注册号：CRD42023438755）。
