Perioperative Antibiotics in Sialendoscopy: A Retrospective Cohort Study

The use of perioperative antibiotics in sialendoscopy is nonstandardized and subject to surgeon preference. This study examines the association between perioperative antibiotic use in interventional submandibular gland sialendoscopy with stone removal and postoperative infection rates.

A multi-institutional retrospective cohort study of academic otolaryngology practices. Patients who underwent sialendoscopy of the submandibular gland for stone removal from January 1, 2015 to December 31, 2023 were included. Data were collected on patient demographics, comorbidities, disease factors, perioperative factors, and antibiotic use. The primary exposure was isolated postoperative antibiotic use. Secondary and tertiary exposures included any perioperative antibiotic use and isolated intraoperative antibiotic use. The primary outcome was postoperative infection.

A total of 399 patients from four institutions were included, with an overall rate of infection of 5.01%. Perioperative antibiotics were used in 57.6% of cases, including intraoperatively in 44.9% and postoperatively in 31.1%. There was no statistically significant difference in infection rates between those who received postoperative antibiotics (RR: 1.48, 95% CI: 0.62-3.53), intraoperative antibiotics (RR: 1.10, 95% CI: 0.46-2.64), any perioperative antibiotics (RR: 1.01, 95% CI: 0.43-2.37), and no antibiotics. Additionally, postoperative antibiotic use was directly associated with age, history of prior sialendoscopy, stent placement, and systemic steroid use, and inversely associated with basket retrieval.

We found no association between the use of perioperative antibiotics and postoperative infection rates. While specific subgroups of patients with complex pathologies or high-risk intraoperative findings may benefit, this study suggests antibiotics are not indicated for routine interventional sialendoscopy procedures on the submandibular glands.