Prolonged antibiotic prophylaxis after pancreatoduodenectomy: systematic review and meta-analysis

Daphne H.M. Droogh*, Jesse V. Groen, Mark G.J. de Boer, Joffrey van Prehn, Hein Putter, Bert A. Bonsing, Casper H.J. van Eijck, Alexander L. Vahrmeijer, Hjalmar C. van Santvoort, Bas Groot Koerkamp, Sven J.D. Mieog

*Corresponding author for this work

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Previous studies have reported conflicting results of prolonged antibiotic prophylaxis on infectious complications after pancreatoduodenectomy. This study evaluated the effect of prolonged antibiotics on surgical-site infections (SSIs) after pancreatoduodenectomy. 


A systematic review and meta-analysis was undertaken of SSIs in patients with perioperative (within 24 h) versus prolonged antibiotic (over 24 h) prophylaxis after pancreatoduodenectomy. SSIs were classified as organ/space infections or superficial SSI within 30 days after surgery. ORs were calculated using a Mantel–Haenszel fixed-effect model.


Ten studies were included in the qualitative analysis, of which 8 reporting on 1170 patients were included in the quantitative analysis. The duration of prolonged antibiotic prophylaxis varied between 2 and 10 days after surgery. Four studies reporting on 782 patients showed comparable organ/space infection rates in patients receiving perioperative and prolonged antibiotics (OR 1.35, 95 per cent c.i. 0.94 to 1.93). However, among patients with preoperative biliary drainage (5 studies reporting on 577 patients), organ/space infection rates were lower with prolonged compared with perioperative antibiotics (OR 2.09, 1.43 to 3.07). Three studies (633 patients) demonstrated comparable superficial SSI rates between patients receiving perioperative versus prolonged prophylaxis (OR 1.54, 0.97 to 2.44), as well as in patients with preoperative biliary drainage in 4 studies reporting on 431 patients (OR 1.60, 0.89 to 2.88). 


Prolonged antibiotic prophylaxis is associated with fewer organ/space infection in patients who undergo preoperative biliary drainage. However, the optimal duration of antibiotic prophylaxis after pancreatoduodenectomy remains to be determined and warrants confirmation in an RCT.

Original languageEnglish
Pages (from-to)1458-1466
Number of pages9
JournalBritish Journal of Surgery
Issue number11
Publication statusPublished - Nov 2023

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© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.


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