Abstract

Background. Cephalosporin-based antimicrobial prophylaxis is a key measure for preventing surgical site infections (SSIs) in abdominopelvic procedures. More targeted use supports antibiotic stewardship by reducing overall exposure and the incidence of adverse events. The reduced invasiveness of minimally invasive “closed” surgery (robotic and video-laparoscopic) may allow a shorter prophylactic course than open surgery.

Methods. We conducted an observational comparative study of two procedure-matched cohorts of abdominopelvic surgery patients with diabetes mellitus (ages 19–80 years; mean age 44 years). Individuals with both type I and type II diabetes were excluded from the study. The minimally invasive cohort (robotic/video-laparoscopic) included 300 patients (150 women, 150 men), and the open-surgery cohort included 300 patients with the same sex distribution. In both cohorts, perioperative cephalosporin prophylaxis was administered according to institutional protocol; in the minimally invasive group, the postoperative duration was shortened due to lower surgical invasiveness. The primary endpoint was SSI and related infectious complications within 30 days.

Results. At the 30-day follow-up, compared with open surgery, minimally invasive surgery was associated with approximately a one-third reduction in postoperative infections. The effect was consistent in women and men. Shortened prophylaxis was not associated with an increased risk of early infectious events.

Conclusions. In diabetic patients undergoing abdominopelvic surgery, robotic and video-laparoscopic approaches allow shorter cephalosporin prophylaxis and are associated with an ≈approximately 33% reduction in 30-day infections compared with open access, supporting antibiotic stewardship.