K.A. McKie1, D.A. Graham2, S.J. Rangel1 1Boston Children’s Hospital, Surgery, Boston, MA, USA 2Boston Children’s Hospital, Program For Patient Safety And Quality, Boston, MA, USA
Introduction:
Controversy and a lack of rigorous comparative effectiveness data exist surrounding the benefit of postoperative antimicrobial prophylaxis (PAP) in children undergoing minimally invasive pectus excavatum repair. The purpose of this study was to compare outcomes in children undergoing repair who did and did not receive postoperative prophylaxis.
Methods:
Children <18 years undergoing minimally invasive pectus repair were identified from the 2021 and 2022 ACS NSQIP-Pediatric General Participant Use Files (PUF). Outcomes included 30-day postoperative surgical site infection (SSI, including both incisional and organ space infection), reoperation, and inpatient readmission. All outcomes were obtained from the General Participant Use PUF and merged with prophylaxis utilization data from the NSQIP-Pediatric Surgical Antibiotic Prophylaxis PUF. Outcomes were compared between patients who did and did not receive PAP (PAP+ and PAP-, respectively) after propensity matching on patient and operative characteristics (age, race/ethnicity, ASA class, BMI, asthma, chronic lung disease, cardiac risk factors and operative duration).
Results:
2302 patients were included from 157 hospitals. The median age at repair was 15.4 years (IQR: 14.5-16.4) and 87.3% were male. All patients received prophylaxis prior to incision and 55.7% (1281/2302) received postoperative prophylaxis for a median duration of 21.8 hours (IQR: 14.7–25.1). Following matching, no differences were found between groups in any patient or procedural characteristics (figure). The overall SSI rate was 1.7% (incisional: 1.4%; OSI: 0.4%), and SSI rates were similar in children who did and did not receive PAP in the matched analysis (PAP-: 1.7% [16/966] vs. PAP+: 1.7% [16/966]; OR 1.00, 95%CI [0.50-2.01], P=1.0). The overall reoperation rate was 1.7%, and reoperation rates were similar in children who did and did not receive PAP (PAP-: 1.7% [16/966] vs. PAP+: 1.5% [14/966] OR 0.83, 95%CI [0.44-1.58], P=0.63). The overall inpatient readmission rate was 3.3%, and readmission rates were similar in children who did and did not receive PAP (PAP-: 3.6% [35/966] vs. PAP+: 2.8% [27/966] OR 0.77, 95%CI [0.46-1.27], P=0.36).
Conclusion:
Use of postoperative antimicrobial prophylaxis was not associated with lower rates of SSI, reoperation or readmission in children undergoing minimally invasive pectus excavatum repair. These data support the abandonment of postoperative antibiotics to optimize antimicrobial stewardship in this cohort of children.