Targeted antibiotic prophylaxis strategy for pancreatectomies: an analysis of the National Surgical Quality Improvement Program

Background: Recent research supports broad-spectrum antibiotic (BSA) prophylaxis in open pancreatoduodenectomy (PD). Minimally invasive surgery (MIS) and distal pancreatectomy (DP) are associated with fewer surgical site infections (SSI), and comparatively less is known about antibiotic choice for these operations. This study seeks to define optimal antibiotic prophylaxis strategy in open and MIS PD and DP. Methods: PD and DP patients were identified from the 2015–2020 National Surgical Quality Improvement Program database. Baseline characteristics, antibiotic choice, and SSI rates were evaluated using univariate and multivariate analyses. Results: We included 19535 PDs (92.3% open, 7.7% MIS) and 10844 DPs (53% open, 47% MIS). In open PD, BSA was associated with decreased odds of SSI compared to cephalosporins (OR 0.79, 95% CI: 0.72–0.82). In MIS PD, open DP, and MIS DP, antibiotic choice was not significantly associated with SSI rates. Conclusion: BSA prophylaxis was associated with fewer SSI in open PD, but not MIS PD or either open or MIS DP. Routine prophylaxis with cephalosporins provides adequate coverage for these groups and overuse of BSA should be avoided.