Data from: Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews

Introduction: Many researchers have addressed over-dosage and
inappropriate use of antibiotics. Many meta-analyses have investigated
antibiotic prophylaxis for low-risk laparoscopic cholecystectomy with the
aim of reducing unnecessary antibiotic use. Most of these meta-analyses
have concluded that prophylactic antibiotics are not required for low-risk
laparoscopic cholecystectomies. This study aimed to assess the validity of
this conclusion by systematically reviewing these meta-analyses. Methods:
A systematic review was undertaken. Searches were limited to meta-analyses
and systematic reviews. PubMed and Cochrane Library electronic databases
were searched from inception until March 2016 using the following keyword
combinations: “antibiotic prophylaxis”, “laparoscopic cholecystectomy”,
and “systematic review or meta-analysis”. Two independent reviewers
selected meta-analyses or systematic reviews evaluating prophylactic
antibiotics for laparoscopic cholecystectomy. All of the randomized
controlled trials (RCTs) analyzed in these meta-analyses were also
reviewed. Results: Seven meta-analyses regarding prophylactic antibiotics
for low-risk laparoscopic cholecystectomy that had examined a total of 28
RCTs were included. Reviewing of these meta-analyses revealed 48 miscounts
of the number of outcomes. Six RCTs were inappropriate for the
meta-analyses; one targeted patients with acute cholecystitis, another
measured inappropriate outcomes, the original source of a third was not
found, and the study protocols of the remaining three were not appropriate
for the meta-analyses. After correcting the above miscounts and excluding
the six inappropriate RCTs, pooled risk ratios were recalculated. These
showed that, contrary to what had previously been concluded, antibiotics
significantly reduced the risk of postoperative infections. The rates of
surgical site, distant, and overall infections were all significantly
reduced by antibiotic administration (risk ratio [95% confidence
interval]; 0.71 [0.51–0.99], 0.37 [0.19–0.73], 0.50 [0.34–0.75],
respectively). Conclusions: Prophylactic antibiotics reduce the incidence
of postoperative infections after elective laparoscopic cholecystectomy.