Effect of Antibiotic Prophylaxis on Surgical Site Infection in Thyroid and Parathyroid Surgery: A Systematic Review and Meta-Analysis

Abstract

Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The purpose of this systematic review is analyzing whether the postoperative SSI rate in thyroid and parathyroid surgery is altered by the practice of AP. We searched Pubmed, Scopus, the Cochrane Library, and Web of Science (WOS) for studies comparing AP to no preoperative antibiotics up to October 2021. Data on the SSI rate was evaluated and summarized as relative risks (RR) with 95% confidence intervals (95% CI). Risk of bias of studies were assessed with standard methods. Nine studies (4 RCTs and 5 nRCTs), including 8710 participants, were eligible for quantitative analysis. A meta-analysis showed that the SSI rate was not significantly different between AP and no preoperative antibiotics (SSI rate: 0.6% in AP vs. 2.4% in control group; RR 0.69, 0.43–1.10 95% CI, p = 0.13, I2 = 0%). A sensitivity analysis and subgroup analysis on RCTs were consistent with the main findings. Evidence of low quality supports that AP in thyroid and parathyroid surgery produce similar SSI rates as to the absence of perioperative antibiotics.

Surgical site infections in thyroid and parathyroid surgery in Japan: An analysis of the Japan Nosocomial Infections Surveillance database from 2013 to 2020

“…Myssiorek et al reported that age ≥80 years, male sex, BMI of 40–50 kg/m 2 , current smoking and ventilation within 48 hours preceding surgery are also risk factors 23 . Generally, thyroid surgery is a clean procedure, and prophylactic antibiotics are not recommended 24‐27 . However, we argue that prophylactic antibiotics should also be considered in thyroid surgery, as the incidence of SSI is three to four times higher in patients with a general condition worse than ASA 3 and in those whose operation lasts longer than the duration of surgery in the 75th percentile or above.…”

Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study

“…Morbidity is mainly represented by hypoparathyroidism, recurrent laryngeal nerve injury, cervical haematoma and wound infection. These complications lead to a reduction in the quality of life of the patients and increased costs for healthcare systems [24][25][26][27][28][29][30][31][32][33].…”

Prophylactic antibiotics may not be necessary for transoral endoscopic thyroidectomy

“…It results in no skin scarring and requires only a relatively small skin flap in the gingival mucosa. In conventional open thyroidectomy, there is no need for prophylactic antibiotics usage to prevent surgical site infection because the thyroidectomy wound that occurs as a result of the use of an anterior neck approach is a clean wound ( 9 ). However, in TOET surgery, the oral cavity is the incision site and this is considered part of the alimentary tract, so the TOET wound is not considered a clean wound, but a clean-contaminated wound ( 4 , 10 ).…”