Effect of Broad‐Spectrum Antibiotic Prophylaxis on Post‐Pancreatoduodenectomy Infectious Complications: Nationwide Inpatient Database Study in Japan

ABSTRACT Background Despite improvements in surgical techniques and perioperative management, the incidence of postoperative surgical site infection after pancreatoduodenectomy remains high. This study aim to assess whether broad‐spectrum antibiotic prophylaxis can reduce complications after pancreatoduodenectomy compared with standard care antibiotics. Methods Data of patients who underwent pancreatoduodenectomy between July 2010 and March 2022 were extracted from a nationwide Japanese inpatient database. First‐ and second‐generation cephalosporins were designated as narrow‐spectrum, and third‐ and fourth‐generation cephalosporins and piperacillin–tazobactam as broad‐spectrum antibiotics. Patients who received either narrow‐ or broad‐spectrum antibiotics on the day of surgery were included in the analysis. Using propensity‐score stabilized inverse probability of treatment weighting, the postoperative complications were compared between patients who received antimicrobial prophylaxis with narrow‐spectrum antibiotics versus broad‐spectrum antibiotics. Results From among 45 099 eligible patients, 36 742 (81.5%) and 8357 (18.5%) patients received narrow‐ and broad‐spectrum antibiotics, respectively. After stabilized inverse probability of treatment weighting, the use of broad‐spectrum antibiotics bore a significant association with the reduction in intra‐abdominal infections [risk difference (RD), −7.4; 95% confidence interval (CI), −8.7 to −6.0], postoperative pancreatic fistula (RD, −3.0; 95% CI, −4.0 to −1.9), post‐pancreatectomy hemorrhage (RD, −1.5; 95% CI, −1.9 to −1.1). The use of broad‐spectrum antibiotics was also associated with a shorter postoperative length of hospital stay and lower total hospitalization costs. The proportion of Clostridioides difficile infection did not differ between the groups. Conclusions The administration of broad‐spectrum antibiotics as antimicrobial prophylaxis was associated with better in‐hospital postoperative outcomes compared with narrow‐spectrum in patients undergoing pancreatoduodenectomy.