Preoperative cefazolin prophylaxis prevents surgical site infection in patients undergoing open and thoracoscopic surgery for lung cancer. A case-control study.

BACKGROUND: Wedge resection and lobectomy by means of video-assisted thoracoscopic surgery (VATS) and open surgery are the treatment of choice in patients with early stage lung cancer (LC). The advantages of VATS include less postoperative pain, shorter hospital stay and quicker return to preoperative activity. There is also evidence that VATS is less immunosuppressive and morbid than open lobectomy, eliciting a milder inflammatory response. Postoperative infections are not infrequent in thoracic surgery, but surgical site infection (SSI) are unusual. It is unclear which antibiotic regimen provides the best prophylaxis against SSI. The aim of this study was to evaluate the usefulness of preoperative cefazolin prophylaxis in preventing SSI in patients with LC undergoing VATS or open surgery. PATIENTS & METHODS: We prospectively considered 149 patients (median age 63, range 49-68 years) with LC selected for surgery. Patients were randomly assigned to receive either preoperative prophylactic antibiotic regimen cefazolin (2 g I.V., N=71, Group A) or none antimicrobial prophylaxis (N=78, Group B). Seventy (47.0%) patients underwent VATS wedge resection, while 79 (53.0%) underwent open lobectomy via thoracotomy. VATS approach was performed using three standard ports located on the chest wall in relation to the lesion, while in open procedures a posterolateral thoracotomy was used. Chi-square test and Fisher’s exact test were used to analyze results. RESULTS: Age and gender distribution did not differ between Groups (p=NS). Overall, 5 (3.3%) patients developed SSI within 30 days after surgery. All SSIs were observed among Group B (p=0.03). Open lobectomy vs. VATS was a weak risk factor for SSI developing (RR=1.18, 95% CI 0.87-1.60, p=0.26). There was a trend towards longer stay after open surgery (7.1±2.3 days) compared to VATS (5.6±2.7 days, p<0.01). CONCLUSIONS: Our study confirms that the SSI rate is low, especially after minimally invasive VATS procedures, showing that cefazolin prophylaxis represents a useful and cost-effective way to reduce the risk of SSI in patients with LC undergoing surgery.