Retrospective evaluation of surgical site infection after open splenectomies with and without perioperative prophylactic antibiotic coverage

Abstract

Objectives Perioperative prophylactic antibiotics (PPA) are widely used in veterinary medicine to prevent surgical site infections (SSI). Current guidelines advocate the use in clean procedures only if surgeries exceed 90 minutes, or in patients with an ASA score ≥3. Procedure specific recommendations are currently lacking. The following study aimed to analyze the protective effect of PPA in dogs undergoing open splenectomy.

Methods The electronic database of our institution was searched for dogs that underwent splenectomy between 10/2017 and 01/2023. Data collection included age at presentation, breed, weight, reason for splenectomy, diagnosis, ASA class, PPA regime, surgery time, anesthesia time, lowest blood oxygen concentration during anesthesia, lowest body temperature, and lowest blood pressure during surgery as well as duration of hospitalization. Dogs were included if a follow-up of 30 days after surgery was available, or if death occurred within this timeframe.

Results A total of 112 dogs were included. Of these, 46 dogs received PPA, and 66 did not. Most dogs were classified ASA 3 or higher (PPA 87%, non-PPA 80.3%). One SSI (1.5% SSI rate) occurred in the non-PPA group (overall SSI rate 0.9%). Due to the low SSI rate, statistical analysis of risk factors for SSI development was not possible.

Conclusion The described infection rate of 1.5% without PPA indicates, that splenectomy does not qualify as high-risk surgery for SSI, even in patients with ASA class 3 or higher.

Clinical Relevance As splenectomies are frequently performed, the findings of the current study could have a major impact on the overall antimicrobial burden in routine veterinary practice.

Zusammenfassung

Einleitung Perioperative prophylaktische Antibiosen (PPA) werden in der Kleintiermedizin häufig eingesetzt um postoperative Infektionen (SSI) zu verhindern. Aktuelle Leitlinien empfehlen den Einsatz bei sauberen Eingriffen >90 Minuten oder bei Patienten mit ASA-Klasse ≥3. Eingriffsspezifische Empfehlungen fehlen jedoch bislang. Ziel dieser Studie war es, die protektive Wirkung von PPA bei offenen Splenektomien beim Hund zu erfassen.

Methoden Die elektronische Datenbank unseres Instituts wurde retrospektiv nach Hunden, die zwischen 10/2017 und 01/2023 einer Splenektomie unterzogen wurden, durchsucht. Alter, Rasse, Gewicht, Grund für die Splenektomie, Diagnose, ASA-Klasse sowie das PPA-Regime, die Operationszeit, die Anästhesiezeit, die niedrigste Blutsauerstoffkonzentration, Körpertemperatur und der niedrigste Blutdruck während der Anästhesie sowie die Dauer der Hospitalisation wurden erfasst. Hunde wurden eingeschlossen, wenn Informationen über den klinischen Verlauf bis zu Tag 30 bekannt waren (auch wenn die Hunde während dieser Zeit verstarben).

Ergebnisse Es wurden 112 Hunde eingeschlossen. Von diesen erhielten 46 Hunde eine PPA und 66 nicht. Die meisten Hunde wurden als ASA 3 oder höher eingestuft (87% mit PPA, 80,3% ohne PPA). Bei einem Hund ohne PPA trat eine Infektion auf (SSI-Rate insgesamt 0,9%, 1,5% ohne PPA). Aufgrund der niedrigen SSI-Rate war es nicht möglich, den Einfluss der erfassten Faktoren auf die Infektionsrate zu ermitteln.

Schlussfolgerung Die beschriebene Infektionsrate von 1,5% ohne PPA deutet darauf hin, dass eine Splenektomie selbst bei Patienten mit ASA-Klasse ≥3 keinen Risikoeingriff für postoperative Infektionen darstellt.

Klinische Relevanz Da Splenektomien häufig durchgeführt werden, könnten die Ergebnisse der aktuellen Studie einen großen Einfluss auf die Gesamtmenge der eingesetzten Antibiotika in der Kleintierchirurgie haben.

Key words

Surgical site infection - clean surgery - ASA class - Ligasure - prophylactic antibiotics - short-term survival

Schlüsselwörter

Postoperative Infektionen - Saubere Operation - ASA Klasse - Ligasure - prophylaktische Antibiotikatherapie - Kurzzeit-Überlebensrate

Publikationsverlauf

Eingereicht: 28. Januar 2023

Angenommen: 05. Mai 2023

Artikel online veröffentlicht:
11. August 2023

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