Abstract
Objective:
Surgical site infection (SSI) is rare in patients undergoing thyroidectomy. International guidelines do not recommend the usage of antimicrobial prophylaxis (AP) for thyroid surgery, and this study aims to find whether such guidelines hold ground in a developing country like India.

Study design:
This prospective comparative study included 293 patients who underwent thyroidectomy at a single institution.

Setting:
The study was conducted in a tertiary referral hospital (Amrita institute of medical sciences, Kochi, Kerala, India) between 2017 - 2019.

Methods:
One group undergoing thyroidectomy received AP, and others did not. Incidence of SSI was assessed in all patients during in-patient stay, 10th day and 30th day. Details of the data collected include the patient’s age, gender, co-morbidity, nutritional status, operative and drain duration, and length of stay in the hospital.

Results:
Out of 293 patients, five cases of SSI were diagnosed in the group without AP (Four – superficial SSI and one - deep incisional SSI) and zero cases in the group with AP. Our study revealed an infection rate of 1.7 % in thyroid surgery. There was no statistically significant difference in the incidence of SSI in patients with and without AP (p=0.152). In multivariate analysis, type 2 Diabetes Mellitus (p=0.016) and overweight/obesity (p=0.045) were independent risk factors for SSI.

Conclusion:
Our results were found to be in synchronization with international guidelines and concluded that AP is not a necessary pre-operative preparation for all patients undergoing thyroidectomy but in a developing country like India, multiple factors could predispose patients to SSI, resulting in significant strain on the hospital and the patient's financial resources. Patients with Type 2 Diabetes Mellitus and overweight/obese patients may be considered high-risk patients in whom selective antimicrobial prophylaxis may be beneficial.

Key words: surgical site infections, thyroidectomy, antimicrobial prophylaxis