Are Prophylactic Antibiotics Required in Thyroidectomies?

Abstract

Objective: In clean surgical wounds, the rate of infection ranges between 0.3% and 5%. Although postoperative prophylactic antibiotics use is not recommended, practice depends on surgeon preference. We wish to report our rate of postsurgical wound infection requiring antibiotic use following thyroidectomies and parathyroidectomies, where no preoperative or postoperative antibiotic prophylaxis was used. Method: A retrospective chart review of thyroidectomies and parathyroidectomies without additional procedures from January 2005 to June 2011 was undertaken. The incidence of mild and significant postsurgical wound infections, use of antibiotics, need for readmission, surgical drainage, length of hospitalization, and potential risk factors for postsurgical wound infections were assessed. Results: Of 767 charts reviewed, 697 met the inclusion criteria. Six hundred eighteen thyroidectomies and 95 parathyroidectomies were undertaken, 21 requiring postoperative drains. Nine (1.29%) were on antibiotics preoperatively, and 3 (0.43%) were on postoperative prophylactic antibiotics. Nine (1.31% of patients not on antibiotics) were given oral antibiotics for symptoms of mild infection. Two (0.29%) more significant infections required intravenous antibiotic therapy 16 and 20 days postoperatively, 1 necessitating readmission for 4 days and seroma drainage, although a wound drain was placed intraoperatively. Surgical drains (1/11 infections; P = .29) and obesity (4/11 infections, P = .28), among others, were not statistically significant risk factors for postsurgical wound infections. Conclusion: Although prophylactic antibiotics were not used for our thyroidectomies and parathyroidectomies, our rate of postsurgical wound infections (1.6%) was comparative to current literature values (0.3%-5%). Our results suggest that it might not be beneficial or cost-effective to use prophylactic antibiotics in such clean procedures; a randomized control trial is planned.