Benefits and Risks Associated With Antibiotic Prophylaxis for Thyroid Operations

Area of Science:

• Surgical oncology
• Infectious disease prevention
• Clinical outcomes research

Background:

• Prophylactic antibiotics (pABX) are frequently administered before thyroid surgery, despite the procedure being classified as clean.
• The necessity and efficacy of pABX in thyroidectomy remain subjects of investigation.

Purpose of the Study:

• To evaluate the association between prophylactic antibiotic use and the incidence of surgical site infections (SSI) in patients undergoing thyroidectomy.

Main Methods:

• A cohort study included adult patients undergoing thyroid operations between 2010 and 2019.
• Propensity score matching was used to control for patient demographics and comorbidities influencing SSI risk.
• The primary outcome was 30-day SSI, identified through diagnosis codes and/or antibiotic use.

Main Results:

• Of 2411 patients, 56.3% received pABX, often with higher comorbidity scores.
• Unadjusted SSI incidence was higher in the pABX group (6.1% vs. 3.4%).
• After propensity score matching, pABX use was not associated with a reduced risk of overall 30-day SSI or SSI requiring intervention.

Conclusions:

• Prophylactic antibiotic use was not associated with a decreased incidence of SSI in a large, comorbid cohort undergoing thyroid surgery.
• These findings suggest that routine pABX may be low-value in thyroidectomy.
• Deimplementation of prophylactic antibiotics in thyroid surgery should be considered to optimize patient care and resource allocation.