Prophylactic Intravenous Antibiotic Use in Thyroglossal Duct and Branchial Cleft Cyst Excision: A NSQIP-P Analysis

To identify patterns in prophylactic intravenous antibiotics (PIAB) usage for thyroglossal duct and branchial cleft cyst excisions, and to evaluate whether PIAB improve patient outcomes.

Retrospective cohort study.

American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) Surgical Antibiotic Prophylaxis Database.

The NSQIP-P database was queried for pediatric patients (≤18) from 2021 to 2023 who underwent thyroglossal duct or branchial cleft cyst excision. Multivariate regressions assessed associations between PIAB use and outcomes including surgical site infection, unplanned readmission, and reoperation while adjusting for clinicodemographic factors (age, sex, race/ethnicity, admission status, surgical specialty, ASA classification, and wound classification).

Of 2106 TGDC and 2837 BCC patients, 83.5% and 68.0% received PIAB, respectively. Hispanic ethnicity, postoperative admission, and clean-contaminated wound classification were associated with increased PIAB use in both groups. In BCC patients, younger age and treatment by non-otolaryngologists predicted decreased PIAB use. While univariate analysis in TGDC cases showed lower infection rates with PIAB (OR, 0.52; 95% CI, 0.30-0.95; P = .025), this was not significant on multivariate analysis (0.59, 0.34-1.08, P = .074). PIAB did not significantly affect infection, readmission, or reoperation rates in either cohort on multivariate analysis.

PIAB use in pediatric TGDC and BCC excisions varies with clinicodemographic factors but did not consistently reduce adverse outcomes. These findings underscore the need to reevaluate the necessity of PIAB and encourage further investigations to develop evidence-based guidelines for pediatric neck mass surgery.