Surgical antibiotic prophylaxis utilization for pediatric thyroid operations: A NSQIP-Pediatric analysis
Erica C Arnold1, Yueran Zhang1, Kris R Jatana2
1Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Surgical antibiotic prophylaxis (SAP) is used in less than half of pediatric thyroid operations. While SSI risk is low, SAP may benefit patients with thyrotoxicosis or high BMI undergoing total thyroidectomy.
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.
Introduction:
Thyroid operations are generally clean procedures. However, there are no pediatric-specific guidelines regarding surgical antibiotic prophylaxis (SAP) for thyroid operations. This study aims to understand SAP utilization for thyroid operations in children and its association with surgical site infection (SSI).
Methods:
Patients <18 years old who underwent clean thyroid lobectomy and total thyroidectomy between 2021 and 2023 were identified in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Patients with pre-existing infection and non-clean wound class were excluded. A single institutional cohort was also analyzed. SSI rates were compared between those who did and did not receive SAP.
Results:
Among the 1040 thyroid procedures, 45.1% received SAP. SAP was administered more commonly by pediatric (69.0%) and adult otolaryngologists (48.7%) compared to pediatric (30.3%) and general surgeons (14.2%, p < 0.001). The SSI rate in the entire cohort was 0.6% (n = 6). All SSIs occurred in the no-SAP group (1.1%, p = 0.035 when compared to SAP group). All patients with SSI underwent total thyroidectomy. Of the six patients with SSI, 83.3% (n = 5) had thyrotoxicosis, 83.3% (n = 5) had BMI >85th percentile, and 66.7% (n = 4) were ASA III. The number needed to treat for SAP administration was 95.2 to prevent one SSI. The SSI rate in the single institution analysis with minimal SAP administration was 1.3%.
Conclusions:
SSI risk following pediatric thyroid operations is extremely low. Patients undergoing total thyroidectomy for thyrotoxicosis and those with BMI >85th percentile may be subgroups for whom SAP should be considered. Others warrant appropriate antibiotic stewardship and are unlikely to benefit.
