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Surgical antibiotic prophylaxis use in pediatric and adolescent ovarian surgery: A NSQIP-Pediatric analysis
Erica C Arnold1, Yueran Zhang1, Geri Hewitt2
1Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Surgical antibiotic prophylaxis (SAP) is frequently used in pediatric ovarian surgery, but its overall benefit in reducing surgical site infections (SSI) is minimal. SAP may be considered for obese pediatric patients, but not generally recommended for others.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Infectious Disease
Background:
- Current guidelines recommend against surgical antibiotic prophylaxis (SAP) for laparoscopic ovarian procedures in adults.
- These guidelines exclude pediatric patients (<18 years old).
- Understanding SAP use and its impact on surgical site infections (SSI) in pediatric ovarian surgery is crucial.
Purpose of the Study:
- To investigate the utilization of SAP in pediatric ovarian surgeries.
- To determine the association between SAP and SSI rates in this patient population.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program - Pediatrics database (2021-2023).
- Inclusion of patients <18 years undergoing clean ovarian surgery (salpingo-oophorectomy, ovarian sparing surgery, oophorectomy).
- Comparison of SSI rates between patients who received SAP and those who did not.
Main Results:
- SAP was administered in 50.5% of 2,137 pediatric ovarian surgeries.
- Overall SSI risk was low at 1.1%, with a significantly lower rate in patients receiving SAP (0.5% vs. 1.8%, p=0.003).
- SAP use was associated with decreased SSI risk (OR 0.24), while high BMI (>85th percentile) was associated with increased SSI risk (OR 3.20).
Conclusions:
- SAP administration in pediatric ovarian surgery is common but varies by surgical specialty.
- While statistically significant, the overall clinical benefit of SAP for reducing SSI in this population is limited.
- SAP may be considered for pediatric patients with a BMI >85th percentile, but its routine use in other pediatric patients undergoing ovarian surgery is not supported by this study.
Introduction:
The American College of Obstetricians and Gynecologists recommends avoidance of surgical antibiotic prophylaxis (SAP) for laparoscopic ovarian procedures. However, these recommendations do not reference patients <18 years old. This study aims to understand SAP use in pediatric ovarian surgery and its association with surgical site infection (SSI).
Methods:
Perioperative SAP details and SSI rates from the National Surgical Quality Improvement Program - Pediatrics database were obtained for patients <18 years undergoing clean ovarian surgery, including salpingo-oophorectomy (USO), ovarian sparing surgery (OSS), and oophorectomy, from 2021 to 2023 and supplemented with a detailed review of relevant patients at our institution. SSI rates were compared in those who did and did not receive SAP.
Results:
Among 2137 ovarian surgeries, 50.5% received SAP. Patients undergoing open procedures were more likely to receive SAP than laparoscopic (69.1% vs 45.9%, p < 0.001). Pediatric and adult general surgeons (64.8% and 64.9%) administered SAP more than gynecologists (24.2%, p < 0.001). Overall SSI risk was 1.1% (n = 24): 0.5% (n = 5) with SAP and 1.8% with no-SAP (n = 19, p = 0.003). SSI rate was 1.9% in oophorectomy and 1.0% in OSS. On multivariable analysis, SAP was associated with decreased SSI (OR 0.24, 95% CI:0.08-0.62, p = 0.006). SSI was associated with BMI >85th percentile (OR 3.20, 95% CI:1.41-10.3, p = 0.038).
Conclusion:
SAP administration in pediatric ovarian procedures is common and variable between specialties. Overall SSI risk is low, suggesting that while SAP administration is statistically significant in this analysis, it is not clinically significant. For patients with BMI >85th percentile, SAP may be considered, but others are unlikely to significantly benefit.
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