Broad-spectrum antibiotic prophylaxis for pancreatoduodenectomy: Assessment of early adoption of randomized trial...

Patients who receive piperacillin-tazobactam when undergoing pancreatoduodenectomy have reduced postoperative surgical site infection, pancreatic fistula, and sequelae of surgical site infection compared with patients who received cefoxitin, supporting broad-spectrum penicillin prophylaxis as standard care. However, evidence-based practices can take years to integrate widely, and the rate of clinical uptake after pragmatic surgical trials is undefined. Our objective was to evaluate broad-spectrum antimicrobial use in pancreatoduodenectomy after the dissemination of level I evidence supporting this practice.

Patients undergoing pancreatoduodenectomy from 2017 to 2024 were identified using the American College of Surgeons National Surgical Quality Improvement Program pancreatectomy targeted database. A regression discontinuity analysis using a logistic model was constructed to assess changes in practice around trial publication. An additional mixed-model logistic regression was used to evaluate patient predictors influencing antibiotic use.

Among the 27,294 patients from 220 hospitals, broad-spectrum use was 38.2% before dissemination of findings and 56.2% after trial publication. An increase in use of broad-spectrum antibiotics was coincident with the study publication (time by publication status interaction; odds ratio, 1.40; 95% confidence interval, 1.09-1.81), with more hospitals demonstrating an increase in use than either no change or decrease in use. Patients with an indwelling preoperative biliary stent demonstrated greater odds of broad-spectrum antibiotic use (odds ratio, 1.25; 95% confidence interval, 1.05-1.48), whereas Black/African American race was associated with lower odds of receiving broad-spectrum prophylaxis (odds ratio, 0.70; 95% confidence interval, 0.50-0.98).

Increased broad-spectrum penicillin use for pancreatoduodenectomies was observed, especially in patients with biliary stents, following recent evidence supporting its use as standard practice.