The Efficacy and Safety of Using Prophylactic Antibiotics Perioperative Laparoscopic Cholecystectomy; A Prospective Observational Cohort Study

The Efficacy and Safety of Using Prophylactic Antibiotics Perioperative Laparoscopic Cholecystectomy; A Prospective Observational Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Efficacy and Safety of Using Prophylactic Antibiotics Perioperative Laparoscopic Cholecystectomy; A Prospective Observational Cohort Study Ahmad Yamen Arnaout, Abd Alazeez Atli, Yaman Nerabani, Ola Hamdan, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3655827/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Antibiotic prophylaxis is recommended by many guidelines for laparoscopic cholecystectomy. However, the effectiveness and safety of this measure remain controversial due to the fact that most recommendations are based on old and low-quality evidence. Methods: A total of 325 patients who underwent laparoscopic cholecystectomy at Aleppo University Hospital between February 1, 2022 and November 30, 2022 were involved in the study. Inclusion criteria included: laparoscopic cholecystectomy cases, aged between 18 and 90, and patients who accepted to participate in our study. While exclusion criteria included: open cholecystectomy. Results: There was no significant difference in the difficulty of surgical work or perioperative medications between groups. Thirty Complications happened included Wound infection (N=12, PAG = 1, NAG =11; P =0.07), Urinary Tract Infection (N=4 , PAG = 1 , NAG =3 ;P=0.314), bleeding (N=2, PAG = 1, NAG =1; P=0.175), Acute pancreatitis (N=2, PAG = 1, NAG =1; P=0.175), prolonged shoulder pain (N= , PAG =0 , NAG =2 ;P=0.165), intra-abdominal abscess (N=1, PAG =0, NAG =1; P=0.198), Bile leak (N=1, PAG = 1, NAG =0; P=0.056), and other (N=8, PAG = 2, NAG =6; P=0.2). While no case of renal, respiratory (pneumonia), CVA, or Venous thromboembolism complication was recorded during the follow-up period for both groups. Thirteen patients required unplanned readmission and one death occurred in the antibiotic group. Only one case needed ICU care in the antibiotic group. There was a tendency for more complications in patients who did not receive antibiotics in most subgroups, but these results were not statistically significant and require further study with larger patient numbers to determine significance. Conclusion: The medical literature is still unable to answer whether to use PA or not. We tried to cover all possible types of LC and follow them up for a sufficient period. However, future studies with larger samples are needed to solve the debate and improve the present guidelines. Figures Figure 1 1. Introduction Laparoscopic cholecystectomy is considered the preferred surgical technique for managing symptomatic gallstones. This procedure has been shown to reduce postoperative complications compared to open cholecystectomy. However, there is still concern regarding postoperative surgical site infections, although the incidence rate is low( 1 )( 2 ) Antibiotic prophylaxis, which involves administering antibiotics before surgery to prevent infection, is recommended by many guidelines( 3 ), However, the effectiveness and safety of this measure remain controversial due to the fact that most recommendations are based on old and low-quality evidence. The American Society of Health-System Pharmacist's recommendation limits the benefit of antibiotic prophylaxis to high-risk patients.( 4 ) Meta-analyses have demonstrated that there is no significant difference in the incidence of surgical site infections (SSI) among low-risk patients who undergo elective laparoscopic cholecystectomy with or without antimicrobial prophylaxis.( 5 ) At present, the fact that several of the high-risk procedures cannot always be foreseen preoperatively and the occurrence of SSIs leads to higher rates of sickness, longer hospital stays, and a significant financial strain on healthcare systems and based on SSIs are recognized as the most prevalent infections associated with healthcare ( 6 ), so many primary studies are still being conducted in order to consider the results of the meta-analysis and indeed, many of them reach opposite results. ( 7 )( 8 ) This paper aims to evaluate the efficacy and safety of prophylactic antibiotics in laparoscopic cholecystectomy and their impact on patient outcomes. 2. Methods The study was performed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.( 9 ) 2.1. Participants and Allocation A total of 325 patients who underwent laparoscopic cholecystectomy at Aleppo University Hospital between February 1, 2022 and November 30, 2022 were involved in the study. Verbal consent was also obtained from all patients who enrolled in the study. The study protocol was according to the ethical guidelines of the 1964 Declaration of Helsinki and its later update. Additionally, this study was approved by The Ethical Review Board of Faculty of Medicine, University of Aleppo, Syria. Inclusion criteria included: laparoscopic cholecystectomy cases, aged between 18 and 90, and patients who accepted to participate in our study. While exclusion criteria included: open cholecystectomy. Patients who took prophylactic antibiotics (PAG) prior to surgery and those not received antibiotics (NAG) were observed after a month of discharge. 2.2. Pre-operation Details Prior to elective surgery, all patients were admitted on the same day or the day before of operation. Moreover, all operations were conducted by consultants and senior year residents. Before the surgery, some doctors prescribed antibiotics, and other doctors did not. The following data were collected for each patient: age, sex, body mass index, smoking status, comorbidities, as well as performed laboratory tests. The the American Society of Anaesthesiologists (ASA) physical status classification was used as a health status description of the patients. they were categorized into five grades. ( 10 ) 2.3. Operative Details All laparoscopic cholecystectomy was performed under general anesthesia. Surgeons used four trocars and a section between 10-mm clips of the cystic duct and artery. The gallbladder was always retrieved through the umbilical port. All details of the surgery were recorded, including indications for cholecystectomy, operative time, difficulty of surgery using Nassar's grade, perioperative drugs, type of cholecystitis if it was inflamed, and the type of antibiotics. In our study, we considered prophylactic antibiotics as those used before or during the first day of surgery to prevent wound infection. 2.4. Post-operative and follow-up Details All patients were followed up at least 30 days after surgery. We contacted with them by a phone call or hospital visit to record any complications such as wound infection, abscess, hemorrhage, pancreatitis, and postoperative prolonged shoulder pain. Moreover, post-surgical complications were categorized into grades according to Clavien-Dindo classification. As well as treatment of complications and drugs prescribed to control the cases were also recorded. 2.5. Statistical Analysis The independent sample t test was used for the analysis of the quantitative independent data, While the Chi-square test was used for the analysis of the qualitative independent data. All tests were two tailed, and significance was defined as a p value < 0.05. Data were analyzed using the SPSS PC version 24.0 statistical software. 3. Results 1.1. Participants and Recruitment In this study, we prospectively followed up 325 patients who underwent laparoscopic cholecystectomy in the general surgery unit at Aleppo University Hospital during the period from February 1 to November 30, 2022, where we followed them for 30 days and analyzed the data to compare the postoperative results among patients who received prophylactic antibiotics (in the perioperative period and those who did not receive any type of antibiotics to extract the efficacy and safety of that use. Where the number of people who received one or more types of antibiotics prophylactically based on the recommendations of the surgical team reached (n1 = 82) patients, while no type of antibiotics was prescribed to the rest of the patients (n2 = 243). Figure 1 Most of the patients included in this study were women, (n = 257 = 79.1%). 1.2. Characteristics of the patients Most of the patients included in this study were women, (n = 257 = 79.1%). There was no statistical difference in age between the two groups (Mean PAG = 45.10, SD = 14.66 Vs mean NAG = 41.39 SD = 13.84, P value = 0.483). There was also no statistical difference in the BMI value between the two groups, where (Mean PAG = 28.6, SD = 5.3 vs Mean NAG = 6.3, SD = 28.7 ; P value = 0.418 ). Moreover, there was no statistical difference of the main characteristics of the patients between two groups, such as gender, and ASA score, and they are detailed and compared in Table 1 . Table 1 Main Characteristics of the patients Characteristic Antibiotics Group Non- Antibiotics Group Total P value Prophylactic Antibiotics 82 243 325 Gender - Male (n, %) 22 (61.1%) 14 (38.9%) 36 (15.5%) 0.163 Age (years) mean, (SD) 45.10 (14.66) 41.39 (13.84) 0.483 ASA 0.647 Class I (n, %) (60, 51.28%) (66, 57.39%) 126 Class II (n, %) (50, 42.73%) (43, 37.39%) 93 Class III (n, %) (7, 5.9%) (6, 5.2%) 13 Class IV (n, %) 0 ,0 0 ,0 0 Class V (n, %) 0 ,0 0 ,0 0 BMI mean, (SD) 28.93 (5.98) 28.54 (6.05) Indication for Cholecystectomy (n, %) Biliary colic 107 (91.45%) 102 (88.69%) 209 0.482 Choledocholithiasis 0 1 (0.89%) 1 0.312 Cholangitis 3 (2.56%) 8 ( 6.9%) 11 0.115 Biliary pancreatitis 1 (0.85%) 1 (0.89%) 2 0.990 Cholecystitis 6 (5.12%) 3 (2.6%) 9 0.320 Smoking A daily smoker (n, %) (24, 20.5%) (19, 16.5%) 43 0.122 An occasional smoker (n, %) (2, 1.7%) (8, 6.9%) 10 0.133 Ex-smoker (n, %) (4, 3.4%) (2, 1.7%) 6 0.420 Non-smoker (n, %) (86, 73.5%) (87, 75.6%) 173 0.941 BMI: Body Mass Index. ASA I: Healthy person , ASA II: Mild systemic disease. ASA III: Severe systemic disease. ASA IV: Severe systemic disease that is a constant threat to life. ASA IV: A moribund person who is not expected to survive without the operation. ASA V: A declared brain-dead person whose organs are being removed for donor purposes. The main indication for surgery in most of the cases included in the study was Biliary colic (n = 290 = 89.2%). 1.3. Co-morbidities and Laboratory findings of the patients There was no statistical difference between the two groups for co-morbidities such as a history of previous abdominal surgery (N = 90, PAG = 17, NAG = 73; P = 0.1), diabetes mellitus (N = 29, PAG = 8, NAG = 21 ; P = 0.76), UTI (N = 23, PAG = 4 Vs. NAG = 19 ; P = 0.369), and chronic immunosuppression (N = 1, PAG = 0, NAG = 1; P = 0.56). The results of laboratory findings were conducted prior to surgery: WBC (Mean PAG = 8.4 SD1 = 3.4 vs Mean NAG = 7.8, SD2 = 4.8 ; P = 0.33), and Glucose (Mean PAG = 111 SD = 28 vs Mean NAG = 105, SD = 38 ; P = 0.63). Also, there was no statistical difference between the two groups in laboratory findings. The rest of the results of laboratory findings and all co- morbidities are listed in Table 2 . Table 2 Co-morbidities and Laboratory findings of the patients Characteristic Antibiotics Group Non- Antibiotics Group Total P value Co-morbidities (n/N) Previous open abdominal 31 36 67 0.419 Diabetes mellitus 9 4 13 0.163 Hypertension requiring medication 24 21 45 0.664 Ischaemic heart disease 2 2 4 0.986 Chronic obstructive pulmonary disease 1 3 4 0.364 Urinary Tract infection 14 7 21 0.119 Chronic kidney disease 0 0 0 Known liver cirrhosis 0 1 1 0.312 Past history of COVID-19 infection (within the last 12 months) 2 5 7 0.240 Cerebrovascular accident 0 1 1 0.312 Deep Vein Thrombosis 0 0 0 Asthma 1 6 7 0.052 Chronic immunosuppression 1 0 1 0.320 Other 5 7 12 0.533 Laboratory Findings mean (SD)/ N Hemoglobin (g/dL) 12.24 (1.50)/115 12.24 (1.28)/ 115 .983 WBC 10^9/L 7.75 (2.34) / 115 7.46 (2.13) /114 .342 Platelet (103 /µL) 265.77 (83.3) / 111 257.76 (75.1) / 112 .452 Bilirubin Total (mg/dL) 0.6994 (0.52) /106 0.6381 (0.28) / 93 .315 Bilirubin direct (mg/dL) 0.33 (0.84) /98 0.23 (0.17) / 84 .307 Alkaline phosphatase 95.432 (37.5) / 98 90.5 (43.1) /93 .407 AST (U/L) 28.1 (21.5) / 101 26.3 (13.4) /106 .462 ALT (U/L) 24 (13)/102 24 (13) /103 .978 Urea (mg/dL) 28 (10)/98 23.5 (7.8) / 95 .001 Glucose (mg / dl) 102.42(37) /98 101(34) /99 .881 1.4. Perioperative Outcomes There was no statistical difference between the two groups in terms of difficulty of the surgical work (Nassar) degrees, not even the perioperative medications, as shown in Table 3 . Table 3 Perioperative Details Characteristic Antibiotics Group Non- Antibiotics Group Total P value Nassar Grade (n) N1 32/82 118/243 150/325 0.262 N2 28/82 80/243 108/325 0.831 N3 9/82 24/243 33/325 0.831 N4 13/82 20/243 33/325 0.122 Perioperative Medication (n/N) NSAIDs 47/82 157/243 204/325 0.157 Paracetamol 81/82 231/243 312/325 0.292 Opioids 6/82 24/243 30/325 0.322 Ondansetron 26/82 108/243 134/325 0.04 Any cholecystitis (n/N) Acute non complicated 10/82 41/243 51/325 0.001 Pericholecystic collection 0 1/243 1/325 0.594 Mucocele 1/82 2/243 3/325 0.733 Empyema 1/82 7/243 8/325 0.00 The antibiotics that were prescribed to the patients were distributed as follows: Cephalosporin (56/82), Metronidazole (13/82), Penicillin (9/82), Fluoroquinolones (4/82). Table 4 Table 4 Antibiotic Types Characteristic Antibiotics Group Total Prophylactic antibiotic 82 Penicillin 9 Cephalosporins 56 Fluoroquinolones 4 Metronidazol 13 1.5. 30 Days follow-up Outcomes The follow-up period lasted 30 days after the day of surgery, and all patients included in this study were followed up except for 13 of whom could not be followed up due to communication difficulties or because they lived in remote areas. All of those 13 patients were not receiving any kind of antibiotics. After analyzing the results, it was found that the total number of complicated cases amounted to 30 cases in total. These cases were distributed as follows: Wound infection (N = 12, PAG = 1, NAG = 11; P = 0.07), Urinary Tract Infection (N = 4, PAG = 1, NAG = 3 ;P = 0.314), bleeding (N = 2, PAG = 1, NAG = 1; P = 0.175), Acute pancreatitis (N = 2, PAG = 1, NAG = 1; P = 0.175), prolonged shoulder pain (N=, PAG = 0, NAG = 2 ;P = 0.165), intra-abdominal abscess (N = 1, PAG = 0, NAG = 1; P = 0.198), Bile leak (N = 1, PAG = 1, NAG = 0; P = 0.056), and other (N = 8, PAG = 2, NAG = 6; P = 0.2). While no case of renal, respiratory (pneumonia), CVA, Venous thromboembolism complication was recorded during the follow-up period for both groups. On the other hand, 13 of them required unplanned readmission to the hospital (N = 13, PAG = 4, NAG = 9; p = 0.22). Also, one death case was recorded as a result of these complications, and it was from the antibiotic group with p value = 0.02. Moreover, only one case needed to receive ICU care, also from the antibiotic group with p value = 0.056. All of the above complications of surgery during the follow-up period were analyzed and included in Table 5 . Table 5 30 Days follow-up Outcomes Outcome Antibiotics Group Non- Antibiotics Group Total P value Total Complication (n/N) 7/82 23/243 30/325 0.222 Wound infection 1/82 11/243 12/325 0.07 Bleeding 1/82 1/243 2/325 0.175 Bile leak (minor) with no established bile duct injury and resolution without intervention 1/82 0 1/325 0.056 Intra- abdominal abscess 0 1/243 1/325 0.198 Acute pancreatitis 1/82 1/243 2/325 0.175 Urinary tract infection 1/82 3/243 4/325 0.314 Prolonged postoperative shoulder pain 0 2/243 2/325 0.165 Other 2/82 6/243 8/325 0.2 Clavien-Dindo classification (n/N) Grade I 3/82 14/243 17/325 0.201 Grade II 2/82 7/243 9/325 0.229 Grade III 1/82 2/243 3/325 0.228 Grade IV 1/82 0 1/325 0.056 Grade V Table 6 Aleppo University Hospital Team First Name Middle Name Last Name Email ORCID Affiliation Abdallah Dabbit [email protected] 0000-0002-2316-2315 M.D, Faculty of Medicine, University of Aleppo, Aleppo University Hospital, Aleppo, Syrian Arab Republic. Mohamad Zaher Shahrour [email protected] 0000-0003-4564-6318 M.D, Faculty of Medicine, University of Aleppo, Aleppo University Hospital, Aleppo, Syrian Arab Republic. Wael Alkhaleel [email protected] 0000-0003-2478-3583 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. HASAN MOHAMMAD ALHASAN [email protected] 0000-0001-5986-7838 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. Nour Lbabidi [email protected] 0000-0003-2607-7914 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. Ahmad Alhaj [email protected] 0000-0002-6573-5265 ‏ M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. Hilal Mohammad Matar [email protected] 0000-0001-7014-9714 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. Amer Zidany [email protected] 0000-0002-4786-4389 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. Shergal Tammo [email protected] 0000-0002-5566-1661 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. Mousa Ahmad Sifat [email protected] 0000-0001-9521-3647 M.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic. 1.6. Sub-Groups Analysis There was no statistical difference between the two groups according to the subgroups of the ASA, the Co-morbidities, the severity of cholecystitis, and the different indications for the cholecystectomy, except for the patients indicated for non-inflamed cholecystectomy regarding to Clavien-Dindo classification Grade I complications (N = 13, PAG = 1, Vs. NAG = 12, P value = 0.036). Supplementary File A There is a tendency to have more complications in patients who did not receive antibiotics in most subgroups, but these results are not statistically significant and need studies with larger numbers of patients to prove this and determine the statistical significance. 4. Discussion It is necessary to wisely use antibiotics to avoid developing resistance and for cost effectiveness. However, using prophylactic antibiotics (PA) before LC is controversial. The most prominent postoperative complication after LC in our study in both groups was wound infection without statistical difference between them. A previous meta-analysis found that PA significantly decreased postoperative superficial SSI but not deep SSI. However, it included only elective low risk patients and cannot be generalized.( 11 ) An RCT studied both low and high-risk patients did not find an association between PA and postoperative complications, but its small sample size in addition to use only one dose of antibiotics limit the reliability of the conclusion.( 12 ) Other meta-analysis found that only one dose of PA did not significantly lower the postoperative infections unlike 2–3 doses.( 13 ) Another retrospective study found that PA did not add any benefit to both low and high-risk patients. But it also may rarely cause serious complications such as anaphylactic shock, C. difficile infection, and imply additional costs.( 14 ) No statistical differences were found regarding other complications such as bile leak (minor), intra-abdominal abscess, acute pancreatitis, urinary tract infection, and prolonged postoperative shoulder pain. Which coincided with previous trails. ( 12 , 14 ) On the other hand Matsui et al. recommended routine application of PA even after low-risk elective LC, they found in their trail that it lowers postoperative infectious complications and medical costs.( 15 ) These results may be attributed to the sufficient sample size, most of the other studies' sample sizes were underpowered and may not detect the significant differences when relatively rare phenomena are studied. However, Subgroup analysis reveal no statistically significant differences between control and study groups regarding ASA and co-morbidities subgroups. Smith et al. found similar results in the term of co-morbidities such as diabetes, BMI > 30, steroid therapy, ASA > 2, and Immunosuppression.( 14 ) There are also some limitations to our study, as most of our sample were females (cholecystectomy is more common in females than men). Our study did not study the financial aspect, as the hospital is academic and all patients were provided with free care. Moreover, we did not calculate the number of a sample in a statistical way, but rather we relied on including all qualified patients based on the study criteria within nine months and one center. As conclusion, the medical literature is still unable to answer whether to use PA or not. We tried to cover all possible types of LC and follow them up for a sufficient period. However, future studies with larger samples are needed to solve the debate and improve the present guidelines. Declarations Funding None. Author Contribution Ahmad Yamen Arnaout: Study Coordinator, validation, data analysis, data interpretation, writing – original draft and reviewing.Abd Alazeez Atli: Data interpretation, Data entry, writing – original draft and reviewing.Yaman Nerbani: Data Cleaning, Data entry, Correspondence, writing – original draft and reviewing.Ola Hamdan: Data collection, and writing – original draft.Ezeddin Dabbagh: Data collection, and writing – original draft.Tala Jouma Alhejazi: writing – original draft.Lama Kadoura: Validation and reviewing the manuscript.Ruqaya Masri: Validation and reviewing the manuscript.Adel Bsata: Scientific supervision, and validation. Hasan Kayali; Scientific supervision, and validation.Nehad Mahli; Scientific supervision, and validation.Ahmad Al-Haj; Scientific supervision, and validation.Kusay Ayoub; Scientific supervision, and validation.Ammar Niazi; Scientific supervision, and validation.Ahmad Ghazal; Study coordinator, Scientific supervision, validation, and reviewing the manuscript.Aleppo University Hospital Team; Data collection Team. Acknowledgment We thank everyone who contributed to collecting data and investigating patients, and the names are shown in Table 6 . Data Availability Statement The full data is available in Supplementary File B . References Brand M, Bizos D, O’Farrell PJ. Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. Cochrane Database of Systematic Reviews. 2010;(12). Versus E, Cholecystectomy D, Trial AMR, Kipfm K. Acute Cholecystitis. 2013;258(3):385–93. Leaper DJ, Edmiston CE. World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect. 2017;95(2):135–6. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-System Pharm. 2013;70(3):195–283. Pasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27–34. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-System Pharm. 2013;70(3):195–283. Van Braak WG, Ponten JEH, Loozen CS, Schots JPM, Van Geloven AAW, Donkervoort SC, et al. Antibiotic prophylaxis for acute cholecystectomy: PEANUTS II multicentre randomized non-inferiority clinical trial. Br J Surg. 2022;109(3):267–73. Matsui Y, Satoi S, Kaibori M, Toyokawa H, Yanagimoto H, Matsui K et al. Antibiotic prophylaxis in laparoscopic cholecystectomy: A randomized controlled trial. PLoS ONE. 2014;9(9). Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies [Internet]. Vol. 370, . Available from: www.plosmedicine.org. Saklad M, Rovenstine E, Taylor I. American Society of Anaesthesiologists physical status classification. 2011;55(2):111–5. Kim SH, Yu HC, Yang J, Do, Ahn SW, Hwang HP. Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis. 2018;231–47. Kim HJ, Kang SH, Roh YH, Kim MC, Kim KW. Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk ? 2017;0–5. Yang J, Gong S, Lu T, Tian H, Jing W, Liu Y et al. Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta analysis. Surg Endosc. 2021;(0123456789). Griffen FD. HHS Public Access. 2019;84(4):576–80. Matsui Y, Satoi S, Kaibori M, Toyokawa H, Yanagimoto H, Matsui K et al. Antibiotic prophylaxis in laparoscopic cholecystectomy: A randomized controlled trial. PLoS ONE. 2014;9(9). Additional Declarations No competing interests reported. Supplementary Files SupplementaryFileASubgroupsanalysis.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abd","middleName":"Alazeez","lastName":"Atli","suffix":""},{"id":252594050,"identity":"35b154fd-485a-45aa-bc14-d159a2139c27","order_by":2,"name":"Yaman Nerabani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYJADxgdAgoePFC3MBiAtbKRoYZMAk4SUGRw/nfi5cIcNA397d1rl1xw7GTYG5oePbuDTciZ3s/TMM2kMEmfObrstuy0Z6DA2Y+McfFoO5G6Q5m07zGAgkbvttuQ2ZqAWHjZpvFrOv938m7ftP1hLseS2eiK03MjdBrTlAFgL48dthwlrkbzxdps1b1syD9Avm6UZtx3nYWMm4Be+87mbb/O22cnxt/du/PhzW7U9P3vzw8f4tCgcgNA8IIIZQuJRDgLyDUgcxh8EVI+CUTAKRsHIBAAd1kUQ5aN7tAAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of Medicine, University of Aleppo","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yaman","middleName":"","lastName":"Nerabani","suffix":""},{"id":252594051,"identity":"16577495-daca-4751-8729-b7be8c8610fd","order_by":3,"name":"Ola Hamdan","email":"","orcid":"","institution":"Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ola","middleName":"","lastName":"Hamdan","suffix":""},{"id":252594052,"identity":"d7ccc679-19b4-42a6-a1b3-75d07ef8cad7","order_by":4,"name":"Ezeddin Dabbagh","email":"","orcid":"","institution":"Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ezeddin","middleName":"","lastName":"Dabbagh","suffix":""},{"id":252594053,"identity":"149f655a-485d-4e71-bc3c-5570e2a8dfb4","order_by":5,"name":"Tala Jouma Alhejazi","email":"","orcid":"","institution":"Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tala","middleName":"Jouma","lastName":"Alhejazi","suffix":""},{"id":252594054,"identity":"ad882b92-55d7-4aa7-b378-cb2a908ac92c","order_by":6,"name":"Lama Kadoura","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lama","middleName":"","lastName":"Kadoura","suffix":""},{"id":252594055,"identity":"4cfd9a2d-f040-4e61-b49a-eaf98f1ed462","order_by":7,"name":"Ruqaya Masri","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ruqaya","middleName":"","lastName":"Masri","suffix":""},{"id":252594056,"identity":"8268c49d-7ffe-493d-a269-1b03dd468e57","order_by":8,"name":"Adel Bsata","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Adel","middleName":"","lastName":"Bsata","suffix":""},{"id":252594057,"identity":"4408a302-bdfe-4017-a4ce-98ff414efc17","order_by":9,"name":"Hasan Kayali","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Kayali","suffix":""},{"id":252594058,"identity":"567c6380-b894-4fa7-89dd-85c3c581eb7c","order_by":10,"name":"Nehad Mahli","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nehad","middleName":"","lastName":"Mahli","suffix":""},{"id":252594059,"identity":"b87a027d-0871-4caf-84c9-eeff4c671eed","order_by":11,"name":"Ahmad Al-Haj","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Al-Haj","suffix":""},{"id":252594060,"identity":"3ce5f4d3-a9db-4141-bf61-cf0afae9401d","order_by":12,"name":"Kusay Ayoub","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kusay","middleName":"","lastName":"Ayoub","suffix":""},{"id":252594061,"identity":"1a11d7a8-5730-4b8d-a9b4-92de0bdb41a2","order_by":13,"name":"Ammar Niazi","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ammar","middleName":"","lastName":"Niazi","suffix":""},{"id":252594062,"identity":"a711165e-ccc3-4602-9e1b-a33a8ead2939","order_by":14,"name":"Ahmad Ghazal","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine, University of Aleppo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Ghazal","suffix":""}],"badges":[],"createdAt":"2023-11-23 19:29:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3655827/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3655827/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":47225187,"identity":"b25d7aa3-8bda-444c-9d7c-9a68d3be55b0","added_by":"auto","created_at":"2023-11-28 19:22:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41796,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProfile of the Study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3655827/v1/cd5efa8fcb52551aaf6039fc.png"},{"id":48770890,"identity":"af83c4af-2d83-4fdc-a6bc-304a2d08459a","added_by":"auto","created_at":"2023-12-25 11:22:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":673273,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3655827/v1/e5df8726-7925-40ce-9e81-33b214d6c0a1.pdf"},{"id":47225189,"identity":"9747208a-e8b3-4ea0-ae20-57ecffbd199b","added_by":"auto","created_at":"2023-11-28 19:22:53","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":390304,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFileASubgroupsanalysis.docx","url":"https://assets-eu.researchsquare.com/files/rs-3655827/v1/bb2dd342f02993dbdd4580e8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Efficacy and Safety of Using Prophylactic Antibiotics Perioperative Laparoscopic Cholecystectomy; A Prospective Observational Cohort Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eLaparoscopic cholecystectomy is considered the preferred surgical technique for managing symptomatic gallstones. This procedure has been shown to reduce postoperative complications compared to open cholecystectomy. However, there is still concern regarding postoperative surgical site infections, although the incidence rate is low(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Antibiotic prophylaxis, which involves administering antibiotics before surgery to prevent infection, is recommended by many guidelines(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), However, the effectiveness and safety of this measure remain controversial due to the fact that most recommendations are based on old and low-quality evidence.\u003c/p\u003e \u003cp\u003eThe American Society of Health-System Pharmacist's recommendation limits the benefit of antibiotic prophylaxis to high-risk patients.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Meta-analyses have demonstrated that there is no significant difference in the incidence of surgical site infections (SSI) among low-risk patients who undergo elective laparoscopic cholecystectomy with or without antimicrobial prophylaxis.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAt present, the fact that several of the high-risk procedures cannot always be foreseen preoperatively and the occurrence of SSIs leads to higher rates of sickness, longer hospital stays, and a significant financial strain on healthcare systems and based on SSIs are recognized as the most prevalent infections associated with healthcare (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), so many primary studies are still being conducted in order to consider the results of the meta-analysis and indeed, many of them reach opposite results. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis paper aims to evaluate the efficacy and safety of prophylactic antibiotics in laparoscopic cholecystectomy and their impact on patient outcomes.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study was performed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants and Allocation\u003c/h2\u003e \u003cp\u003eA total of 325 patients who underwent laparoscopic cholecystectomy at Aleppo University Hospital between February 1, 2022 and November 30, 2022 were involved in the study. Verbal consent was also obtained from all patients who enrolled in the study. The study protocol was according to the ethical guidelines of the 1964 Declaration of Helsinki and its later update. Additionally, this study was approved by The Ethical Review Board of Faculty of Medicine, University of Aleppo, Syria.\u003c/p\u003e \u003cp\u003eInclusion criteria included: laparoscopic cholecystectomy cases, aged between 18 and 90, and patients who accepted to participate in our study. While exclusion criteria included: open cholecystectomy.\u003c/p\u003e \u003cp\u003ePatients who took prophylactic antibiotics (PAG) prior to surgery and those not received antibiotics (NAG) were observed after a month of discharge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Pre-operation Details\u003c/h2\u003e \u003cp\u003ePrior to elective surgery, all patients were admitted on the same day or the day before of operation. Moreover, all operations were conducted by consultants and senior year residents. Before the surgery, some doctors prescribed antibiotics, and other doctors did not. The following data were collected for each patient: age, sex, body mass index, smoking status, comorbidities, as well as performed laboratory tests. The the American Society of Anaesthesiologists (ASA) physical status classification was used as a health status description of the patients. they were categorized into five grades. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Operative Details\u003c/h2\u003e \u003cp\u003eAll laparoscopic cholecystectomy was performed under general anesthesia. Surgeons used four trocars and a section between 10-mm clips of the cystic duct and artery. The gallbladder was always retrieved through the umbilical port.\u003c/p\u003e \u003cp\u003eAll details of the surgery were recorded, including indications for cholecystectomy, operative time, difficulty of surgery using Nassar's grade, perioperative drugs, type of cholecystitis if it was inflamed, and the type of antibiotics. In our study, we considered prophylactic antibiotics as those used before or during the first day of surgery to prevent wound infection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Post-operative and follow-up Details\u003c/h2\u003e \u003cp\u003eAll patients were followed up at least 30 days after surgery. We contacted with them by a phone call or hospital visit to record any complications such as wound infection, abscess, hemorrhage, pancreatitis, and postoperative prolonged shoulder pain. Moreover, post-surgical complications were categorized into grades according to Clavien-Dindo classification. As well as treatment of complications and drugs prescribed to control the cases were also recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe independent sample t test was used for the analysis of the quantitative independent data, While the Chi-square test was used for the analysis of the qualitative independent data. All tests were two tailed, and significance was defined as a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Data were analyzed using the SPSS PC version 24.0 statistical software.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Participants and Recruitment\u003c/h2\u003e \u003cp\u003eIn this study, we prospectively followed up 325 patients who underwent laparoscopic cholecystectomy in the general surgery unit at Aleppo University Hospital during the period from February 1 to November 30, 2022, where we followed them for 30 days and analyzed the data to compare the postoperative results among patients who received prophylactic antibiotics (in the perioperative period and those who did not receive any type of antibiotics to extract the efficacy and safety of that use.\u003c/p\u003e \u003cp\u003eWhere the number of people who received one or more types of antibiotics prophylactically based on the recommendations of the surgical team reached (n1\u0026thinsp;=\u0026thinsp;82) patients, while no type of antibiotics was prescribed to the rest of the patients (n2\u0026thinsp;=\u0026thinsp;243). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMost of the patients included in this study were women, (n\u0026thinsp;=\u0026thinsp;257\u0026thinsp;=\u0026thinsp;79.1%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Characteristics of the patients\u003c/h2\u003e \u003cp\u003eMost of the patients included in this study were women, (n\u0026thinsp;=\u0026thinsp;257\u0026thinsp;=\u0026thinsp;79.1%). There was no statistical difference in age between the two groups (Mean PAG\u0026thinsp;=\u0026thinsp;45.10, SD\u0026thinsp;=\u0026thinsp;14.66 Vs mean NAG\u0026thinsp;=\u0026thinsp;41.39 SD\u0026thinsp;=\u0026thinsp;13.84, P value\u0026thinsp;=\u0026thinsp;0.483). There was also no statistical difference in the BMI value between the two groups, where (Mean PAG\u0026thinsp;=\u0026thinsp;28.6, SD\u0026thinsp;=\u0026thinsp;5.3 vs Mean NAG\u0026thinsp;=\u0026thinsp;6.3, SD\u0026thinsp;=\u0026thinsp;28.7 ; P value\u0026thinsp;=\u0026thinsp;0.418 ). Moreover, there was no statistical difference of the main characteristics of the patients between two groups, such as gender, and ASA score, and they are detailed and compared in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain Characteristics of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon- Antibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProphylactic Antibiotics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender - Male (n, %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (61.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years) mean, (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.10 (14.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.39 (13.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass I (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(60, 51.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(66, 57.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass II (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(50, 42.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(43, 37.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass III (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7, 5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(6, 5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass IV (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 ,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 ,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass V (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 ,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 ,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI mean, (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.93 (5.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.54 (6.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndication for Cholecystectomy (n, %)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiliary colic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (91.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102 (88.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholedocholithiasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholangitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 ( 6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiliary pancreatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholecystitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA daily smoker (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(24, 20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(19, 16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAn occasional smoker (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2, 1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(8, 6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEx-smoker (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4, 3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2, 1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-smoker (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(86, 73.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(87, 75.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI: Body Mass Index.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eASA I: Healthy person\u003c/b\u003e,\u003c/p\u003e \u003cp\u003e\u003cb\u003eASA II: Mild systemic disease.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eASA III: Severe systemic disease.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eASA IV: Severe systemic disease that is a constant threat to life.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eASA IV: A moribund person who is not expected to survive without the operation.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eASA V: A declared brain-dead person whose organs are being removed for donor purposes.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe main indication for surgery in most of the cases included in the study was Biliary colic (n\u0026thinsp;=\u0026thinsp;290\u0026thinsp;=\u0026thinsp;89.2%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e1.3. Co-morbidities and Laboratory findings of the patients\u003c/h2\u003e \u003cp\u003eThere was no statistical difference between the two groups for co-morbidities such as a history of previous abdominal surgery (N\u0026thinsp;=\u0026thinsp;90, PAG\u0026thinsp;=\u0026thinsp;17, NAG\u0026thinsp;=\u0026thinsp;73; P\u0026thinsp;=\u0026thinsp;0.1), diabetes mellitus (N\u0026thinsp;=\u0026thinsp;29, PAG\u0026thinsp;=\u0026thinsp;8, NAG\u0026thinsp;=\u0026thinsp;21 ; P\u0026thinsp;=\u0026thinsp;0.76), UTI (N\u0026thinsp;=\u0026thinsp;23, PAG\u0026thinsp;=\u0026thinsp;4 Vs. NAG\u0026thinsp;=\u0026thinsp;19 ; P\u0026thinsp;=\u0026thinsp;0.369), and chronic immunosuppression (N\u0026thinsp;=\u0026thinsp;1, PAG\u0026thinsp;=\u0026thinsp;0, NAG\u0026thinsp;=\u0026thinsp;1; P\u0026thinsp;=\u0026thinsp;0.56). The results of laboratory findings were conducted prior to surgery: WBC (Mean PAG\u0026thinsp;=\u0026thinsp;8.4 SD1\u0026thinsp;=\u0026thinsp;3.4 vs Mean NAG\u0026thinsp;=\u0026thinsp;7.8, SD2\u0026thinsp;=\u0026thinsp;4.8 ; P\u0026thinsp;=\u0026thinsp;0.33), and Glucose (Mean PAG\u0026thinsp;=\u0026thinsp;111 SD\u0026thinsp;=\u0026thinsp;28 vs Mean NAG\u0026thinsp;=\u0026thinsp;105, SD\u0026thinsp;=\u0026thinsp;38 ; P\u0026thinsp;=\u0026thinsp;0.63). Also, there was no statistical difference between the two groups in laboratory findings. The rest of the results of laboratory findings and all co- morbidities are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCo-morbidities and Laboratory findings of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon- Antibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCo-morbidities (n/N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious open abdominal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension requiring medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIschaemic heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary Tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnown liver cirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePast history of COVID-19 infection (within the last 12 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebrovascular accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeep Vein Thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic immunosuppression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory Findings mean (SD)/ N\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.24 (1.50)/115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.24 (1.28)/ 115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.983\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWBC 10^9/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.75 (2.34) / 115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.46 (2.13) /114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlatelet (103 /\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265.77 (83.3) / 111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e257.76 (75.1) / 112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilirubin Total (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6994 (0.52) /106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6381 (0.28) / 93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilirubin direct (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33 (0.84) /98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23 (0.17) / 84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlkaline phosphatase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.432 (37.5) / 98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.5 (43.1) /93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.1 (21.5) / 101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3 (13.4) /106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (13)/102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (13) /103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrea (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (10)/98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.5 (7.8) / 95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlucose (mg / dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102.42(37) /98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101(34) /99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e1.4. Perioperative Outcomes\u003c/h2\u003e \u003cp\u003eThere was no statistical difference between the two groups in terms of difficulty of the surgical work (Nassar) degrees, not even the perioperative medications, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative Details\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon- Antibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNassar Grade (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e150/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerioperative Medication (n/N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e204/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParacetamol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e231/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e312/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpioids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOndansetron\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny cholecystitis (n/N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute non complicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePericholecystic collection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucocele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmpyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe antibiotics that were prescribed to the patients were distributed as follows: Cephalosporin (56/82), Metronidazole (13/82), Penicillin (9/82), Fluoroquinolones (4/82). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntibiotic Types\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProphylactic antibiotic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePenicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetronidazol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e1.5. 30 Days follow-up Outcomes\u003c/h2\u003e \u003cp\u003eThe follow-up period lasted 30 days after the day of surgery, and all patients included in this study were followed up except for 13 of whom could not be followed up due to communication difficulties or because they lived in remote areas. All of those 13 patients were not receiving any kind of antibiotics.\u003c/p\u003e \u003cp\u003eAfter analyzing the results, it was found that the total number of complicated cases amounted to 30 cases in total.\u003c/p\u003e \u003cp\u003eThese cases were distributed as follows: Wound infection (N\u0026thinsp;=\u0026thinsp;12, PAG\u0026thinsp;=\u0026thinsp;1, NAG\u0026thinsp;=\u0026thinsp;11; P\u0026thinsp;=\u0026thinsp;0.07), Urinary Tract Infection (N\u0026thinsp;=\u0026thinsp;4, PAG\u0026thinsp;=\u0026thinsp;1, NAG\u0026thinsp;=\u0026thinsp;3 ;P\u0026thinsp;=\u0026thinsp;0.314), bleeding (N\u0026thinsp;=\u0026thinsp;2, PAG\u0026thinsp;=\u0026thinsp;1, NAG\u0026thinsp;=\u0026thinsp;1; P\u0026thinsp;=\u0026thinsp;0.175), Acute pancreatitis (N\u0026thinsp;=\u0026thinsp;2, PAG\u0026thinsp;=\u0026thinsp;1, NAG\u0026thinsp;=\u0026thinsp;1; P\u0026thinsp;=\u0026thinsp;0.175), prolonged shoulder pain (N=, PAG\u0026thinsp;=\u0026thinsp;0, NAG\u0026thinsp;=\u0026thinsp;2 ;P\u0026thinsp;=\u0026thinsp;0.165), intra-abdominal abscess (N\u0026thinsp;=\u0026thinsp;1, PAG\u0026thinsp;=\u0026thinsp;0, NAG\u0026thinsp;=\u0026thinsp;1; P\u0026thinsp;=\u0026thinsp;0.198), Bile leak (N\u0026thinsp;=\u0026thinsp;1, PAG\u0026thinsp;=\u0026thinsp;1, NAG\u0026thinsp;=\u0026thinsp;0; P\u0026thinsp;=\u0026thinsp;0.056), and other (N\u0026thinsp;=\u0026thinsp;8, PAG\u0026thinsp;=\u0026thinsp;2, NAG\u0026thinsp;=\u0026thinsp;6; P\u0026thinsp;=\u0026thinsp;0.2). While no case of renal, respiratory (pneumonia), CVA, Venous thromboembolism complication was recorded during the follow-up period for both groups. On the other hand, 13 of them required unplanned readmission to the hospital (N\u0026thinsp;=\u0026thinsp;13, PAG\u0026thinsp;=\u0026thinsp;4, NAG\u0026thinsp;=\u0026thinsp;9; p\u0026thinsp;=\u0026thinsp;0.22).\u003c/p\u003e \u003cp\u003eAlso, one death case was recorded as a result of these complications, and it was from the antibiotic group with p value\u0026thinsp;=\u0026thinsp;0.02. Moreover, only one case needed to receive ICU care, also from the antibiotic group with p value\u0026thinsp;=\u0026thinsp;0.056.\u003c/p\u003e \u003cp\u003eAll of the above complications of surgery during the follow-up period were analyzed and included in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e30 Days follow-up Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon- Antibiotics Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Complication (n/N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBile leak (minor) with no established bile duct injury and resolution without intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntra- abdominal abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute pancreatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProlonged postoperative shoulder pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClavien-Dindo classification (n/N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAleppo University Hospital Team\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLast Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmail\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eORCID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAffiliation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdallah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDabbit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0000-0002-2316-2315\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D, Faculty of Medicine, University of Aleppo, Aleppo University Hospital, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohamad Zaher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShahrour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0000-0003-4564-6318\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D, Faculty of Medicine, University of Aleppo, Aleppo University Hospital, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWael\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlkhaleel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0003-2478-3583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHASAN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMOHAMMAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eALHASAN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0001-5986-7838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLbabidi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0003-2607-7914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlhaj\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0002-6573-5265 \u0026rlm;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHilal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMohammad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMatar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0001-7014-9714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZidany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0002-4786-4389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShergal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTammo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0002-5566-1661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMousa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAhmad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSifat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\[email protected]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0000-0001-9521-3647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eM.D. Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e1.6. Sub-Groups Analysis\u003c/h2\u003e \u003cp\u003eThere was no statistical difference between the two groups according to the subgroups of the ASA, the Co-morbidities, the severity of cholecystitis, and the different indications for the cholecystectomy, except for the patients indicated for non-inflamed cholecystectomy regarding to Clavien-Dindo classification Grade I complications (N\u0026thinsp;=\u0026thinsp;13, PAG\u0026thinsp;=\u0026thinsp;1, Vs. NAG\u0026thinsp;=\u0026thinsp;12, P value\u0026thinsp;=\u0026thinsp;0.036). \u003cb\u003eSupplementary File A\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThere is a tendency to have more complications in patients who did not receive antibiotics in most subgroups, but these results are not statistically significant and need studies with larger numbers of patients to prove this and determine the statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIt is necessary to wisely use antibiotics to avoid developing resistance and for cost effectiveness. However, using prophylactic antibiotics (PA) before LC is controversial. The most prominent postoperative complication after LC in our study in both groups was wound infection without statistical difference between them. A previous meta-analysis found that PA significantly decreased postoperative superficial SSI but not deep SSI. However, it included only elective low risk patients and cannot be generalized.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) An RCT studied both low and high-risk patients did not find an association between PA and postoperative complications, but its small sample size in addition to use only one dose of antibiotics limit the reliability of the conclusion.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) Other meta-analysis found that only one dose of PA did not significantly lower the postoperative infections unlike 2\u0026ndash;3 doses.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Another retrospective study found that PA did not add any benefit to both low and high-risk patients. But it also may rarely cause serious complications such as anaphylactic shock, C. difficile infection, and imply additional costs.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) No statistical differences were found regarding other complications such as bile leak (minor), intra-abdominal abscess, acute pancreatitis, urinary tract infection, and prolonged postoperative shoulder pain. Which coincided with previous trails. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOn the other hand Matsui et al. recommended routine application of PA even after low-risk elective LC, they found in their trail that it lowers postoperative infectious complications and medical costs.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) These results may be attributed to the sufficient sample size, most of the other studies' sample sizes were underpowered and may not detect the significant differences when relatively rare phenomena are studied.\u003c/p\u003e \u003cp\u003eHowever, Subgroup analysis reveal no statistically significant differences between control and study groups regarding ASA and co-morbidities subgroups. Smith et al. found similar results in the term of co-morbidities such as diabetes, BMI\u0026thinsp;\u0026gt;\u0026thinsp;30, steroid therapy, ASA\u0026thinsp;\u0026gt;\u0026thinsp;2, and Immunosuppression.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThere are also some limitations to our study, as most of our sample were females (cholecystectomy is more common in females than men). Our study did not study the financial aspect, as the hospital is academic and all patients were provided with free care. Moreover, we did not calculate the number of a sample in a statistical way, but rather we relied on including all qualified patients based on the study criteria within nine months and one center.\u003c/p\u003e \u003cp\u003eAs conclusion, the medical literature is still unable to answer whether to use PA or not. We tried to cover all possible types of LC and follow them up for a sufficient period. However, future studies with larger samples are needed to solve the debate and improve the present guidelines.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNone.\u003c/p\u003e \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\n\u003cp\u003eAhmad Yamen Arnaout: Study Coordinator, validation, data analysis, data interpretation, writing \u0026ndash; original draft and reviewing.Abd Alazeez Atli: Data interpretation, Data entry, writing \u0026ndash; original draft and reviewing.Yaman Nerbani: Data Cleaning, Data entry, Correspondence, writing \u0026ndash; original draft and reviewing.Ola Hamdan: Data collection, and writing \u0026ndash; original draft.Ezeddin Dabbagh: Data collection, and writing \u0026ndash; original draft.Tala Jouma Alhejazi: writing \u0026ndash; original draft.Lama Kadoura: Validation and reviewing the manuscript.Ruqaya Masri: Validation and reviewing the manuscript.Adel Bsata: Scientific supervision, and validation. Hasan Kayali; Scientific supervision, and validation.Nehad Mahli; Scientific supervision, and validation.Ahmad Al-Haj; Scientific supervision, and validation.Kusay Ayoub; Scientific supervision, and validation.Ammar Niazi; Scientific supervision, and validation.Ahmad Ghazal; Study coordinator, Scientific supervision, validation, and reviewing the manuscript.Aleppo University Hospital Team; Data collection Team.\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e \u003cp\u003eWe thank everyone who contributed to collecting data and investigating patients, and the names are shown in \u003cb\u003eTable\u0026nbsp;6\u003c/b\u003e.\u003c/p\u003e\u003ch2\u003eData Availability Statement\u003c/h2\u003e \u003cp\u003eThe full data is available in \u003cb\u003eSupplementary File B\u003c/b\u003e.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrand M, Bizos D, O\u0026rsquo;Farrell PJ. Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. Cochrane Database of Systematic Reviews. 2010;(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVersus E, Cholecystectomy D, Trial AMR, Kipfm K. Acute Cholecystitis. 2013;258(3):385\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeaper DJ, Edmiston CE. World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect. 2017;95(2):135\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-System Pharm. 2013;70(3):195\u0026ndash;283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasquali S, Boal M, Griffiths EA, Alderson D, Vohra RS. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg. 2016;103(1):27\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-System Pharm. 2013;70(3):195\u0026ndash;283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Braak WG, Ponten JEH, Loozen CS, Schots JPM, Van Geloven AAW, Donkervoort SC, et al. Antibiotic prophylaxis for acute cholecystectomy: PEANUTS II multicentre randomized non-inferiority clinical trial. Br J Surg. 2022;109(3):267\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsui Y, Satoi S, Kaibori M, Toyokawa H, Yanagimoto H, Matsui K et al. Antibiotic prophylaxis in laparoscopic cholecystectomy: A randomized controlled trial. PLoS ONE. 2014;9(9).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies [Internet]. Vol.\u0026nbsp;370, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.thelancet.com.2007\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Available from: www.plosmedicine.org.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaklad M, Rovenstine E, Taylor I. American Society of Anaesthesiologists physical status classification. 2011;55(2):111\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SH, Yu HC, Yang J, Do, Ahn SW, Hwang HP. Role of prophylactic antibiotics in elective laparoscopic cholecystectomy: A systematic review and meta-analysis. 2018;231\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HJ, Kang SH, Roh YH, Kim MC, Kim KW. Are prophylactic antibiotics necessary in elective laparoscopic cholecystectomy, regardless of patient risk ? 2017;0\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang J, Gong S, Lu T, Tian H, Jing W, Liu Y et al. Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta analysis. Surg Endosc. 2021;(0123456789).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffen FD. HHS Public Access. 2019;84(4):576\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsui Y, Satoi S, Kaibori M, Toyokawa H, Yanagimoto H, Matsui K et al. Antibiotic prophylaxis in laparoscopic cholecystectomy: A randomized controlled trial. PLoS ONE. 2014;9(9).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3655827/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3655827/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAntibiotic prophylaxis is recommended by many guidelines for laparoscopic cholecystectomy. However, the effectiveness and safety of this measure remain controversial due to the fact that most recommendations are based on old and low-quality evidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 325 patients who underwent laparoscopic cholecystectomy at Aleppo University Hospital between February 1, 2022 and November 30, 2022 were involved in the study. Inclusion criteria included: laparoscopic cholecystectomy cases, aged between 18 and 90, and patients who accepted to participate in our study. While exclusion criteria included: open cholecystectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere was no significant difference in the difficulty of surgical work or perioperative medications between groups.\u003cstrong\u003e \u003c/strong\u003eThirty\u003cstrong\u003e \u003c/strong\u003eComplications happened included Wound infection (N=12, PAG = 1, NAG =11; P =0.07), Urinary Tract Infection (N=4 , PAG = 1 , NAG =3 ;P=0.314), bleeding (N=2, PAG = 1, NAG =1; P=0.175), Acute pancreatitis (N=2, PAG = 1, NAG =1; P=0.175), prolonged shoulder pain (N= , PAG =0 , NAG =2 ;P=0.165), intra-abdominal abscess (N=1, PAG =0, NAG =1; P=0.198), Bile leak (N=1, PAG = 1, NAG =0; P=0.056), and other (N=8, PAG = 2, NAG =6; P=0.2). While no case of renal, respiratory (pneumonia), CVA, or Venous thromboembolism complication was recorded during the follow-up period for both groups. Thirteen patients required unplanned readmission and one death occurred in the antibiotic group. Only one case needed ICU care in the antibiotic group. There was a tendency for more complications in patients who did not receive antibiotics in most subgroups, but these results were not statistically significant and require further study with larger patient numbers to determine significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe medical literature is still unable to answer whether to use PA or not. We tried to cover all possible types of LC and follow them up for a sufficient period. However, future studies with larger samples are needed to solve the debate and improve the present guidelines.\u003c/p\u003e","manuscriptTitle":"The Efficacy and Safety of Using Prophylactic Antibiotics Perioperative Laparoscopic Cholecystectomy; A Prospective Observational Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-28 19:22:48","doi":"10.21203/rs.3.rs-3655827/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7db88ef2-157e-4bf2-a947-29c7ae62734c","owner":[],"postedDate":"November 28th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-12-25T11:14:21+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-28 19:22:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3655827","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3655827","identity":"rs-3655827","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}