Surgical Antibiotic Prophylaxis Utilization for Pediatric Thyroid Operations: A NSQIP-Pediatric Analysis

Area of Science:

• Pediatric Surgery
• Surgical Outcomes
• Infectious Disease

Background:

• Thyroid operations are generally clean procedures with no established pediatric-specific guidelines for surgical antibiotic prophylaxis (SAP).
• Understanding SAP utilization and its impact on surgical site infection (SSI) rates in children undergoing thyroid surgery is crucial.

Purpose of the Study:

• To assess the utilization of SAP in pediatric thyroid operations.
• To determine the association between SAP and SSI rates in pediatric patients.

Main Methods:

• Analysis of pediatric thyroid lobectomy and total thyroidectomy cases (2021-2023) from the NSQIP-P database.
• Exclusion of patients with pre-existing infections or non-clean wound classes.
• Comparison of SSI rates between patients who received SAP and those who did not.

Main Results:

• SAP was administered in 45.1% of 1,040 pediatric thyroid procedures.
• The overall SSI rate was low at 0.6%, with all SSIs occurring in the no-SAP group (1.1%).
• Patients with SSI often had total thyroidectomy, thyrotoxicosis, and BMI >85th percentile.

Conclusions:

• The risk of SSI after pediatric thyroid surgery is very low.
• Consider SAP for pediatric patients undergoing total thyroidectomy for thyrotoxicosis or with a BMI >85th percentile.
• Antibiotic stewardship is recommended for other pediatric thyroid surgery patients unlikely to benefit from SAP.