Prophylactic antibiotics in groin hernioplasty: a prospective cohort study on the prevention of surgical site infection

Background: The role of prophylactic antibiotics in preventing surgical site infections (SSI) in clean procedures such as groin hernioplastyremains controversial. This study aimed to evaluate the association between antibiotic prophylaxis and SSI rates in a real-world setting and identify independent risk factors for SSI. Methods: This single-center, prospective cohort study was conducted at Al-Gumhori Teaching Hospital, Sana'a, Yemen. A total of 100 male patients undergoing elective open groin hernioplasty were prospectively followed. Patients were categorized into two groups based on the treating surgeon's decision: those who received a single dose of intravenous cefazolin (Antibiotic Group, n=50), and those who did not receive antibiotic prophylaxis (No Antibiotic Group, n=50). The primary outcome was the incidence of SSI within 30 days. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for SSI. Results: The SSI rate was 6.0% in the antibiotic group and 14.0% in the non-antibiotic group (overall rate 10.0%), respectively (p = 0.318). Multivariate logistic regression analysis identified high BMI (Adjusted OR 17.93, p = 0.041) and prolonged operative time >60 min (Adjusted OR 72.15, p = 0.010) as the only significant independent predictors of SSI. Antibiotic prophylaxis showed a strong but not statistically significant protective trend after adjusting for other factors (Adjusted OR odds ratio [OR], 0.15; 95% confidence interval [CI], 0.018–1.28; p = 0.076). Conclusion: Routine prophylactic antibiotic administration was not significantly associated with a reduction in the SSI rates. A high BMI and prolonged operative time are key drivers of infection risk, supporting a risk-stratified approach in which prophylaxis is targeted to high-risk patients. Clinical trial number: not applicable.