Optimal duration of perioperative antibiotics in radical cystectomy and urinary diversion: a systematic review and meta-analysis

PURPOSE: To evaluate the impact of extended versus nonextended perioperative antibiotic prophylaxis (PAP) on reducing postoperative complications and hospital stays in patients undergoing radical cystectomy and urinary diversion. METHODS: We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing short-term (≤ 24 h) and extended (≥ 24 h) PAP in patients undergoing radical cystectomy and urinary diversion. The primary outcomes were surgical site infections (SSIs), urinary tract infections (UTIs), and length of hospital stay. The statistical analysis was performed via RevMan version 5.3. The results are presented as risk ratios (RRs) and mean differences (MDs). Results are presented as risk ratios (RRs) and mean differences (MDs). The quality of evidence was assessed using the GRADE methodology. RESULTS: A total of 214 studies were screened. Four studies involving 680 patients were included. No significant differences were detected between short-term and extended PAP in terms of SSIs (RR = 0.71 [95% CI 0.43-1.17]; P = 0.18]), febrile UTIs (RR = 1.19 [95% CI 0.91-1.56]; P = 0.20]), or length of hospital stay (MD = 0.76 days [95% CI [-2.72, 4.25]; P = 0.67]). CONCLUSION: No significant difference was observed between 24-h and extended PAP for reducing postoperative complications after radical cystectomy and urinary diversion. Short-term PAP is a reliable and effective strategy and is recommended as the standard practice for reducing antimicrobial resistance and improving postoperative outcomes.