Optimal duration of perioperative antibiotics in radical cystectomy and urinary diversion: a systematic review and meta-analysis

TL;DR

This study compares short-term and extended antibiotic use before and after bladder cancer surgery, finding no significant difference in infection rates or hospital stays.

Contribution

The study provides evidence that short-term antibiotic prophylaxis is as effective as extended use in preventing complications after radical cystectomy.

Findings

Short-term and extended antibiotic use showed no significant difference in surgical site infections.

Hospital stay duration was not significantly affected by the duration of antibiotic prophylaxis.

Short-term antibiotic use is recommended to reduce antimicrobial resistance without compromising patient outcomes.

Abstract

To evaluate the impact of extended versus nonextended perioperative antibiotic prophylaxis (PAP) on reducing postoperative complications and hospital stays in patients undergoing radical cystectomy and urinary diversion.

We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing short-term (≤ 24 h) and extended (≥ 24 h) PAP in patients undergoing radical cystectomy and urinary diversion. The primary outcomes were surgical site infections (SSIs), urinary tract infections (UTIs), and length of hospital stay. The statistical analysis was performed via RevMan version 5.3. The results are presented as risk ratios (RRs) and mean differences (MDs). Results are presented as risk ratios (RRs) and mean differences (MDs). The quality of evidence was assessed using the GRADE methodology.

A total of 214 studies were screened. Four studies involving 680 patients were included. No significant differences were detected between short-term and extended PAP in terms of SSIs (RR = 0.71 [95% CI 0.43–1.17]; P = 0.18]), febrile UTIs (RR = 1.19 [95% CI 0.91–1.56]; P = 0.20]), or length of hospital stay (MD = 0.76 days [95% CI [-2.72, 4.25]; P = 0.67]).

No significant difference was observed between 24-h and extended PAP for reducing postoperative complications after radical cystectomy and urinary diversion. Short-term PAP is a reliable and effective strategy and is recommended as the standard practice for reducing antimicrobial resistance and improving postoperative outcomes.

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