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Optimization of Delivery of Pediatric Otolaryngology Surgical Antibiotic Prophylaxis
Pratyusha Yalamanchi1, Ashley Parent2, Marc Thorne1
1Department of Otolaryngology, Head & Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Insights
Routine perioperative antibiotics for pediatric otolaryngology procedures showed improved timely administration, despite low infection rates. Further antimicrobial stewardship is recommended for evidence-based use.
Area of Science:
- Pediatric Otolaryngology
- Surgical Antibiotic Prophylaxis
- Quality Improvement
Background:
- Limited evidence supports routine perioperative antibiotics for pediatric otolaryngologic procedures.
- Surgical site infection rates are notably low in clean otolaryngology surgery.
- Antibiotic use is common in specific procedures like cochlear implantation and head and neck surgeries.
Purpose of the Study:
- To characterize the case mix for antibiotic use in pediatric otolaryngology.
- To determine the percentage of surgical encounters with appropriate antibiotic timing.
- To improve the delivery of prophylactic antibiotics through quality improvement initiatives.
Main Methods:
- Evaluation of 1520 pediatric otolaryngology procedures (2015-2019).
- Utilized A3 problem-solving for intervention rollout.
- Interrupted time-series analysis to assess antibiotic timing improvements.
Main Results:
- Timely prophylactic antibiotic administration improved significantly from 27.5% to 86.9%.
- Surgical site infection rates remained stable at approximately 2 cases per year.
- Antibiotics were most frequently used in otologic surgeries and clean-contaminated head and neck cases.
Conclusions:
- Continuous performance improvement can optimize evidence-based antibiotic prophylaxis.
- Perioperative antibiotics may not be necessary for most clean otolaryngology procedures.
- Additional antimicrobial stewardship interventions are indicated for pediatric otolaryngology.
Objectives:
There is limited evidence regarding use of routine perioperative antibiotics for pediatric otolaryngologic procedures. The objectives of this quality improvement study were (1) to characterize the otolaryngology case mix for which antibiotics were delivered and (2) determine the percentage of surgical encounters with appropriate timing of antibiotic administration.
Methods:
Pediatric otolaryngology procedures meeting criteria from 2015 to 2019 were evaluated as a component of an institution-wide pediatric surgical antibiotic prophylaxis study using A3 problem solving to identify and roll out interventions for appropriate antibiotic administration. Descriptive statistical analysis of the interrupted time-series data was used to describe the otolaryngology case mix for which antibiotics were delivered. The primary outcome measure was percentage of surgical encounters with appropriate timing of antibiotic administration in minutes relative to incision.
Results:
In total, 1520 pediatric otolaryngology procedures with perioperative antibiotic delivery were performed from July 2015 to September 2019. While surgical site infection number (n = 2/year) was stable, administration of timely prophylactic antibiotics significantly improved: 27.5% of cases per month at baseline and 86.9% at the conclusion of the rollout of the sequential interventions (P < .001).
Discussion:
Given the exceedingly low infection rate of clean otolaryngology surgery, there is limited evidence in favor of perioperative antibiotics for the majority of procedures. Prophylactic antibiotics were most commonly used in otologic surgery involving cochlear implantation or in the setting of draining ears or cholesteatoma and in clean-contaminated head and neck surgery cases.
Implications For Practice:
Iterative continuous performance improvement can optimize evidence-based delivery of preoperative prophylactic antibiotics. Additional interventions to ensure antimicrobial stewardship in pediatric otolaryngology are indicated.
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