Aktueller Stand der Antibiotikaprophylaxe in der Adipositas- und metabolischen Chirurgie – Datenanalyse aus der Studie zur Qualitätskontrolle der operativen Therapie der Adipositas in Deutschland

Zusammenfassung

Hintergrund: Die Studie zur Qualitätssicherung in der operativen Therapie der Adipositas (GBSR) untersucht seit 2005 die aktuelle Situation der Adipositas- und metabolischen Chirurgie in Deutschland. Mithilfe einer Onlinedatenbank werden die Daten prospektiv erfasst und retrospektiv analysiert. Die Datenerfassung erfolgt in Zusammenarbeit mit dem Institut für Qualitätssicherung in der operativen Medizin der Otto-von-Guericke-Universität Magdeburg. Methode: Im Rahmen der prospektiven freiwilligen Datenerfassung werden die Primäroperationen sowie die Re- und Redo-Eingriffe erfasst. Hierbei werden unter anderem Daten zur Antibiotikaprophylaxe dokumentiert und ausgewertet. Ergebnisse: Seit dem Jahr 2005 ist ein stetiger Anstieg der dokumentierten Primäroperationen zu verzeichnen. Die vorliegende Auswertung zur Antibiotikaprophylaxe bezieht sich auf 12 296 Primäreingriffe mit 684 Magenballonimplantationen (BIB), 2950 Magenbandoperationen (Gastric Banding, GB), 5115 Magenbypassoperationen (RYGBP), 120 biliopankreatische Diversionen nach Scopinaro (BPD), 164 Duodenal-Switch-Eingriffe (DS), 3125 Sleeve-Gastrektomien (SG) und 138 weitere Operationen. Insgesamt erfolgte bei 77,3 % der Patienten bei der Primäroperation eine Antibiotikaprophylaxe. Patienten mit Komorbiditäten erhalten signifikant häufiger eine Antibiotikaprophylaxe als Patienten ohne Begleiterkrankungen. Beim Vergleich der Wundinfektionsrate für das GB und die SG findet sich kein signifikanter Unterschied. Fazit: Die Anzahl Adipositas- und metabolisch-chirurgischer Eingriffe hat in Deutschland zugenommen. Zur Notwendigkeit und Dosierung der Antibiotikaprophylaxe existieren in der Literatur nur Empfehlungen geringer Evidenz. Aufgrund der Daten der Qualitätssicherungsstudie für operative Therapie in Deutschland ergibt sich die Empfehlung perioperativer Antibiotikagaben in Abhängigkeit der Komorbiditäten, des BMI und der Operationsdauer.

Abstract

Background: Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Methods: Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Results: Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaroʼs biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Conclusion: Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities.

Schlüsselwörter

Adipositaschirurgie - perioperative Antibiotikaprophylaxe - Antibiotikatherapie - metabolische Chirurgie - morbide Adipositas - Infektion

Key words

obesity surgery - perioperative antibiotic prophylaxis - antibiotic regimen - antibiotic treatment - metabolic surgery - morbid obesity - infection

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