1286 A Closed Loop Audit of the Antibiotic Prophylaxis in Elective Laparoscopic Cholecystectomies at a DGH

Abstract Aim To re-audit the compliance of departmental practice to the antimicrobial guidelines for elective laparoscopic cholecystectomies. A Cochrane review found no evidence to support the use of antibiotic prophylaxis in elective cases. Method A retrospective study looking at all the elective laparoscopic cholecystectomies for the period between 1st June 2023 to 30th September 2023 using local Bluespier theatre software. Electronic operation notes were reviewed to identify cases where antibiotics were given. The main indications were bile spillage, conversion to open and cholecystitis amongst others. Total number of cholecystectomies carried out over the period was 92. At present gentamicin and metronidazole as a single dose was the choice. Results Antibiotic use during laparoscopic cholecystectomy is between 39% and 63% due to many cases not documenting the use of antibiotics. Adherence to guidelines reduced from 36% (2019) to 3% in 2023. Patients who received correct antibiotics allergic to penicillin was 75% (2019) and 100% in 2023. Continued lack of antibiotic documentation, use and indication in operation notes. Continued overuse of co-amoxiclav 60% (2019) and 87% in 2023. Conclusions Antibiotic prophylaxis in elective cholecystectomies was only performed correctly in 3% of cases. This can have a major impact on patient safety and also the financial aspect to the trust. Understanding why surgeons have failed to adopt the local guidelines may benefit in changing practice. We suggested an education session from the microbiology team to help better understand the importance of antibiotic stewardship and using laminated guidelines in theatre to ensure this is followed closely.