La profilaxis antibiótica en pacientes de edad avanzada sometidos a cirugía por hernia de la pared abdominal

Objective. To assess the impact of prophylaxis with a first-generation cephalosporin (cefazolin) on the rate of surgical wound infection in patients over 65 years of age undergoing surgical repair of abdominal wall hernias.
Patients and methods. We review all the patients who underwent surgery to treat abdominal wall hernias in our unit, analyzing prospectively the rate of wound infection according to age group and whether surgery was performed under elective or emergency conditions. The rate of wound infection prior to the use of prophylaxis was 4.9%, differing significantly depending on the age group (3.3% in patients under 65 years of age versus 8.65% in those over 65; p < 0.002). There were also significant differences in terms of the conditions under which the procedure was performed: elective (p < 0.02) or emergency surgery (p < 0.03).
Results. The administration of prophylaxis in the most elderly patients led to an overall rate of infection of 2.4% (1.5% in patients under 65 and 3.7% in those over 65). These results did not differ significantly with respect to the rate of wound infection according to age group or the conditions under which type of surgery was performed.
Conclusions.. Since the management of abdominal wall hernias involves clean surgery, the use of antibiotic prophylaxis in elderly patients is controversial. However, in our experience, it led to a decrease in the incidence of infectious complications, eliminating the age-related differences and, thus, minimizing the greater postoperative morbidity and mortality rates associated with aging