EP 184 Prophylactic Antibiotics in Groin Hernia Repair: Are We Compliant with Current Guidelines? Closed Loop Audit

Background

The international guidelines from the HerniaSurge Collaboration do not recommend routine antibiotic prophylaxis for elective open inguinal mesh hernia repair in average-risk patients in low-risk environments. Antibiotic prophylaxis is also not indicated for laparoscopic repair. This aligns with European and British Hernia Society recommendations and our trust guideline. The aim of this audit was to assess adherence to these guidelines and the impact of the implemented educational interventions.

Methods

Patients undergoing elective inguinal hernia repair with mesh over six months were identified. Data included demographics, operative approach, risk status, and antibiotic use. Following departmental presentation of findings and distribution of educational posters, a second cycle was completed over one month.

Results

In the first cycle, 40 patients were included (mean age 64 years; 93% male). Open, laparoscopic, and robotic repairs were performed in 30, 6, and 4 patients. Of 22 high-risk patients, 6 received guideline-compliant prophylaxis. Antibiotics were prescribed unnecessarily in 32.5% of cases, with overall compliance of 27.1%.

In the second cycle, 13 patients were included (mean age 73 years; 92% male). Open, laparoscopic, and robotic repairs were performed in 9, 2, and 2 patients. Of 11 high-risk patients, 90.9% received guideline-compliant prophylaxis, while 1 of 2 low-risk patients received unnecessary antibiotics. Overall guideline adherence increased to 84.6%.

Conclusion

Initial adherence to local antibiotic prophylaxis guidelines for inguinal hernia repair was poor, with both overuse and inappropriate selection. Targeted educational interventions markedly improved compliance. Ongoing education and periodic re-audit are recommended to sustain improvement and support antimicrobial stewardship.