Surgical site infection (SSI) following bariatric surgery contributes to patient morbidity and additional use of health care resources. We investigated whether a SSI quality control initiative in the form of a refined preoperative antimicrobial protocol affected the rate of SSI following laparoscopic roux-en-y gastric bypass (LRYGB). 

We reviewed all LRYGB procedures performed between June 2015 and December 2016 at a single bariatric surgery centre of excellence. Two preoperative antimicrobial protocols were compared. Patients undergoing surgery prior to February 2016 received 2g of cefazolin whereas patients undergoing surgery after February 1, 2016 received a new antimicrobial protocol consisting of 2g cefazolin, 500mg metronidazole and 30ml oralchlorhexidine rinse. The primary outcome was 30 day SSI including superficial SSI, deep incisional SSI and organ/space infection as defined by the Centre for Disease Control. Clinic charts and provincial electronic medical records were reviewed for emergency department visits, microbiology investigations and physician dictations diagnosing SSI. Outcomes were assessed using a students t-test. 

Two hundred seventy six patients underwent LRYGB of which 167 received the refined antimicrobial protocol and 109 received cefazolin. The refined antimicrobial protocol significantly decreased the rate of deep incisional SSI compared to cefazolin (n = 1, 0.6% vs n = 5, 4.6%; p < 0.05). The refined antimicrobial protocol resulted in an insignificant overall reduction in the rate of superficial SSI (n = 12, 7.2% vs n =13, 11.9%; p > 0.05) and organ/space infection (n = 0, 0.0% vs n = 2, 1.8%; p > 0.05) respectively. 

A preoperative antimicrobial protocol using cefazolin, metronidazole and chlorhexidine oral rinse appears to reduce the rate of SSI following LRYGB. This protocol may be most effective to prevent deep incisional SSI. Additional patient cases or alternative study design including a randomized control trial is required to better understand the efficacy of this protocol.

The role of cefazolin, metronidazole and oral chlorhexidine rinse as preoperative antimicrobial prophylaxis in reducing surgical site infection following bariatric surgery: a quality control initiative