Preoperative Antibiotics May Not Be a Major Factor in Surgical Site Infection Rates in Patients Undergoing Urgent Hemorrhage-Control Laparotomy

Authors:
Julia E Burrows, Chloe Lai, David M Rosenberg, Rogelio E Molina, Alexander C Schwed, Jessica A Keeley, Eric O Yeates

Body of Abstract:
Background: Preoperative antibiotics are recommended for all trauma patients undergoing laparotomy to prevent surgical site infections (SSI). However, in patients who need urgent hemorrhage-control laparotomy, achieving pre-incision antibiotic administration can be challenging due to time constraints, lack of intravenous access, and prioritization of blood transfusions. Given that these patients often have preexisting intra-abdominal contamination and competing interests, we aimed to evaluate whether preoperative antibiotics significantly affect SSI rates in patients undergoing hemorrhage-control laparotomy for trauma.

Methods: The American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from 2020-2023 was queried for patients who underwent hemorrhage-control laparotomy within one hour of presentation. Patients who died within 48 hours of presentation or those who underwent other operations outside of the abdomen were excluded. Included patients were divided into two groups: those who received prophylactic antibiotics prior to laparotomy and those who did not. These groups were then propensity score matched (3:1) using age, sex, comorbidities, mechanism of injury, injury severity, hypotension, number of blood transfusions, and intraabdominal organs injured. Logistic regression was used to compare infectious outcomes between the two groups.

Results: 13,823 patients were identified who underwent hemorrhage control laparotomy within one hour of presentation, 898 of these patients received preoperative antibiotics. Direct comparison of these two groups demonstrated higher rates of SSI in those who received preoperative antibiotics: 8.6% v. 6.1% (p=0.003). 3:1 propensity matching resulted in two groups: 897 who received preoperative antibiotics and 2691 who did not. Standardized mean differences (SMD) for all covariates were < 0.1 after matching. Logistic regression revealed no difference in rates of overall SSIs between the groups [8.6% v 7.4%, OR 1.2 (0.90-1.6), p=0.23]. There was also no difference in rates of superficial incisional SSIs [2.1% v 1.8%, OR 1.2 (0.68-2.0), p=0.57], deep incisional SSIs [2.5% v 2.3%, OR 1.1 (0.65-1.7), p=0.80], or organ space SSIs [4.7% v 3.9%, OR 1.3 (0.92-1.8), p=0.13]. Conclusion: In urgent hemorrhage-control trauma laparotomy cases, which often already have contamination present, pre-incision antibiotic administration may be a less important factor for preventing SSI than previously described. These findings suggest that clinicians may reasonably prioritize resuscitation and hemorrhage control over antibiotic administration when necessary.