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KMID : 0980120220200010030
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Annals of Phlebology
2022 Volume.20 No. 1 p.30 ~ p.36
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Prophylactic Antibiotics for Combined Endovenous Ablation and Phlebectomy, Necessary or Not?: A Propensity Score Matching Case-Control Study
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Yie Kil-Soo
Shin A-Rom
Jeong Eun-Hee
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Abstract
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Objective: Current guidelines recommend that prophylactic antibiotics should not be used in endovenous surgery. However, it remains unclear whether prophylactic antibiotics are necessary for the combined endovenous procedure with concomitant phlebectomy.
Methods: We conducted a propensity score-matched case-control study to assess post-procedural infection rates based on the use or non-use of prophylactic antibiotics. Initially, the study included 587 patients (mean age of 55.8 ±14.2 and 296 (50.4%) women) undergoing combined endovenous surgery with concomitant phlebectomy from 2018 to 2022. All procedures were performed under local anesthesia without any sedation. The primary outcome was to compare the incidence of surgical site wound infection (SSWI) after the combined procedure between the prophylactic antibiotic use (PA group) and non-use group (nPA group). The secondary outcomes were to analyze requirement of antibiotics due to any cause three months postoperatively and determine the incidence of thrombophlebitis requiring antibiotic treatment. After propensity score matching, 201 patients who received prophylactic antibiotics (PA group) and 201 who did not (nPA group) were selected, and the present study analyzed 402 participants.
Results: The mean number of concomitant phlebectomies was 3.54±2.3 in the nPA group and 3.68±2.40 in the PA group (p=ns). The type of endovenous treatment (p=0.79 for VenaSeal, p=0.42 for radiofrequency ablation, p=0.52 for endovenous laser ablation, and p=0.38 for ultrasonographic foam sclerotherapy) and number of phlebectomies (3.61±2.3 in no SSWI group vs. 4.40±5.0 in SSWI group) were not associated with postoperative SSWI incidence. In the logistic regression test, the preoperative great saphenous vein size was a unique risk factor for postoperative SSWI (odds ratio 1.442, 95% confidence interval 1.12∼1.80, p=0.004).
Conclusion: Both nPA and PA strategies had a very low and comparable incidence of SSWI after combined endovenous surgery and concomitant phlebectomy for chronic venous disease treatment. The nPA strategy did not increase post-procedural SSWI. An optimized and individualized protocol for the use of antibiotics is needed.
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KEYWORD
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Varicose veins, Infections, Prophylactic antibiotics, Endovenous surgery, Chronic venous disease
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