Broad-spectrum penicillin-based antibiotics significantly improve outcomes after pancreatoduodenectomy compared to standard care options.

• Surgical site infections dropped by 47% (OR 0.53), and postoperative pancreatic fistula rates decreased by 38% (OR 0.62).
• Patients had shorter hospital stays, averaging 2 days less (MD -2.02).

Implementing broad-spectrum antibiotics could redefine surgical management and reduce complication rates, especially for patients with preoperative biliary drainage.

• In that subgroup, surgical site infections decreased by 55% (OR 0.45) and mortality by 66% (OR 0.34).