A longer duration of prophylactic antibiotic use is associated with reduced pneumonic complications in thoracic surgery: a systematic review and meta-analysis

Background: Thoracic surgeons follow the National Surgical Antibiotic Prophylaxis Guidelines from the National Surgical Antibiotic Prophylaxis (SAP) Guideline Development Workgroup, which recommend IV cefazolin 2g single dose for thoracic surgeries. This differed from previous guidelines where multiple doses are spread out over a 48 hour period. A literature review was conducted to compare postoperative outcomes in thoracic surgery based on prophylactic antibiotic duration, specifically analyzing regimens of less than 24 hours versus those extending to 24 hours or beyond

Methods: We conducted an extensive literature search of PubMed, Scopus, and Embase, covering all records from database inception through March 2025. The review incorporated both randomized controlled trials (RCTs) and observational comparison studies that evaluated the duration of prophylactic antibiotics after thoracic surgery. Data was extracted to compare the rate of postoperative complications between durations of antibiotic use.

Results: We analysed 17 studies comprising 14 RCTs and 3 observational cohort studies totaling 2350 patients. Comparing effects of prophylactic antibiotics for less than versus at least 24 hours, there was no significant difference in rates of wound infections (OR=1.12, 95% CI 0.31 to 4.09, p=0.86) and empyema (OR=2.14, 95% CI 0.37 to 12.26, p=0.39). Nevertheless, there was a higher rate of pneumonia (OR=2.20, 95% CI 1.10 to 4.43, p=0.03) and septic complications (OR=1.87, 95% CI 0.96 to 3.64, p=0.067) in patients with less than 24 hours of antibiotics.

Conclusions: The use of intravenous prophylactic antibiotics in thoracic surgery does reduce the rate of postoperative complications. Use of prophylactic antibiotics for at least 24 hours reduces the rate of pneumonia and other septic complications in patients.