Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From National Surgical Quality
Michael F Basin1, Maithili Gopalakrishnan1, Nicole Ackerman1
1Department of Urology, Upstate Medical University, Syracuse, New York.
Insights
A single dose of preoperative antibiotics may decrease wound complications in longer hypospadias repair procedures. However, due to low complication rates, routine use may not be necessary, especially for lower-risk patients.
Area of Science:
- Pediatric Urology
- Surgical Outcomes Research
Background:
- Limited evidence exists on the efficacy of antimicrobial prophylaxis for hypospadias repair.
- Largest studies to date include only several hundred subjects.
Purpose of the Study:
- To evaluate the association between a single dose of preoperative antibiotics and postoperative outcomes in hypospadias repairs.
- Utilized the National Surgical Quality Improvement Program-Pediatrics database for analysis.
Main Methods:
- Analyzed data from the 2021-2022 National Surgical Quality Improvement Program-Pediatrics database.
- Categorized hypospadias repairs into three groups: distal repairs, proximal/reconstructive repairs, and complication repairs.
- Assessed wound complications (infection, dehiscence) and urinary tract infections (UTI) using multivariable logistic regression.
Main Results:
- 84% of 7613 patients received preoperative antibiotics.
- Overall UTI and wound complication rates were approximately 3%.
- Preoperative antibiotics were associated with decreased wound complications in longer procedures (P = .018).
Conclusions:
- Preoperative antibiotics showed a correlation with reduced wound complications in longer hypospadias repair procedures.
- Given the low overall incidence of postoperative complications, clinicians may consider omitting routine preoperative antibiotics.
- This approach may be particularly suitable for lower-risk patients undergoing hypospadias repair.
Purpose:
Literature supporting antimicrobial prophylaxis for hypospadias repairs is lacking, with largest studies including several hundred subjects. We sought to evaluate the association of a single dose of preoperative antibiotics in hypospadias repairs on postoperative outcomes using the National Surgical Quality Improvement Program Pediatric Registry.
Materials And Methods:
The 2021 to 2022 National Surgical Quality Improvement Program Pediatric Registry was used to categorize hypospadias repairs into 3 groups-(1) 1-stage distal hypospadias repairs, (2) 1-stage proximal hypospadias repairs and second-/third-stage urethroplasties, and (3) repair of hypospadias complications. Patients with missing data regarding preoperative antibiotic prophylaxis administration were excluded. We evaluated the risk of wound complications (wound infection or dehiscence) and UTI. Binomial logistic regressions were performed with selected covariates including age, race, prematurity, relative value unit, operative time, American Society of Anesthesiologists score, and antibiotic prophylaxis.
Results:
There were 5026 patients in group 1, 1428 patients in group 2, and 1159 patients in group 3. A total of 6392 (84.0%) patients received preoperative antibiotics. Overall, the UTI and wound complication rates were approximately 3%. On multivariable analysis, preoperative antibiotics were associated with decreased wound complications in longer procedures (P = .018).
Conclusions:
Preoperative antibiotics correlated with decreased wound complications in longer procedures. Owing to the overall very low incidence of postoperative complications, clinicians should consider omitting preoperative antibiotics in hypospadias repairs, particularly in lower-risk patients.
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