NECESSITY AND COST-EFFECTIVENESS OF ANTIM ICROBIAL PROPHYLAXIS IN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY

The effectiveness of antimicrobial prophylaxis was evaluated on the ba sis of data collected in a study on quality management carried out in 28 East German hospitals, involving 4477 laparoscopic and conventional cholecystectomies (197 of which with revision of the common bile duct ). In 3128 patients a laparoscopic procedure (with consecutive convers ion to an open cholecystectomy in 236 cases) and in 1349 patients a pr imarily conventional open cholecystectomy had been performed (a total of 2217 cases with and 2260 cases without antibiotic cover). The resul ts obtained were significantly better in the group receiving prophylax is than in patients not under antimicrobial cover. This applied to sep tic wound healing disorders, general and specific postoperative compli cations, postoperative chest infections, re-operations and postoperati ve lethality. On the basis of these results, it is strongly recommende d that, in the future, neither laparoscopic nor open conventional chol ecystectomy should be carried out without proper perioperative antimic robial prophylaxis-this all the more so since such measures also resul t in a shorter hospital stay and thus reduced costs.