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Area of Science:

  • Pediatric Surgery
  • Infectious Disease Prevention
  • Clinical Outcomes Research

Background:

  • Postoperative antimicrobial prophylaxis (PAP) is common after pectus excavatum repair.
  • It represents a significant source of avoidable antibiotic use in pediatric surgery.
  • Evidence supporting its routine use in this specific population is limited.

Purpose of the Study:

  • To assess the association between postoperative antibiotic prophylaxis and key outcomes after pectus excavatum repair in children.
  • To compare rates of surgical site infections (SSIs), reoperation, and readmission between patients who received PAP and those who did not.
  • To investigate the relationship between hospital-level PAP usage rates and infection/reoperation/readmission rates.

Main Methods:

  • A retrospective cohort study of 3552 pediatric patients undergoing pectus excavatum repair across 141 hospitals.
  • Propensity score matching was employed to create comparable groups based on patient and operative factors.
  • Mixed-effects models and hospital-level analyses were used to evaluate outcomes and correlations.

Main Results:

  • In the matched cohort (3168 patients), no significant differences in 30-day SSI (1.6% vs 1.8%), reoperation (1.6% vs 1.7%), or readmission (2.6% vs 3.6%) rates were observed between children receiving PAP and those not receiving it.
  • Hospital-level analysis revealed no correlation between PAP use rates and observed-to-expected ratios for SSIs, reoperation, or readmission.
  • The duration of PAP was a median of 21.6 hours.

Conclusions:

  • Postoperative antibiotic prophylaxis following pediatric pectus excavatum repair is not associated with improved surgical outcomes.
  • These findings question the current standard practice of routine PAP in this patient group.
  • Further research may be warranted to refine antibiotic stewardship in pediatric thoracic surgery.