Changes in Clinical Practice After Publication of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY)
Samir Sabharwal1, Ricardo G Becker, Michael J Monument
1From the Department of Surgery, Orthopedic Service, Memorial Sloan Kettering Cancer Center, New York, NY (Sabharwal and Morris), the Department of Orthopedics and Trauma, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil (Becker), the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Monument), the Centre for Evidence-Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada (Schneider), the Department of Orthopedic Surgery, Cliniques Universitaires Saint Luc-Institut Roi Albert II, Université Catholique de Louvain, Brussels, Belgium (Schubert), and the Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (Ghert). Sabharwal is now with the Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
Background:
The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter randomized clinical trial comparing a 1-day with a 5-day postoperative intravenous antibiotic regimen after lower extremity bone tumor resection and endoprosthetic reconstruction. The trial found no difference in surgical site infections between groups, but a markedly increased risk for antibiotic-related complications in the 5-day group. The study was published in January 2022. The objective of this study was to assess the effect of these findings on the clinical practice of musculoskeletal oncologists.
Methods:
We developed an anonymous survey exploring changes in clinical practice after the publication of the PARITY trial and electronically distributed the survey to practicing musculoskeletal oncologists through REDCap in March 2024. Data were analyzed descriptively, and changes in practice from before to after the publication of the PARITY study were analyzed through the Pearson chi-square test.
Results:
We obtained 101 responses from surgeons across six continents. Nearly all respondents (94 of 101, 93%) were aware of the PARITY trial results. Forty respondents (40%) reported a meaningful change in clinical practice after PARITY, most frequently a reduction of antibiotic administration in >75% of patients. After PARITY, the proportion of respondents who reported limiting antibiotics to 24 hours increased from 25% to 51% ( P < 0.001), and the proportion prescribing oral antibiotics after discharge from the hospital declined from 23% to 16% ( P < 0.001). Among those who did not change their practice, personal experience/professional opinion was the most frequently cited reason. Adherence to institutional standards was cited as an additional barrier.
Conclusions:
Many respondents reported meaningful change in their clinical practice after the publication of the PARITY trial, most notably limiting perioperative antibiotics to 24 hours. The complexities influencing the personal decision to adopt a notable change in clinical practice in response to new evidence warrant additional study.
Level Of Evidence:
IV.
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