Postoperative antibiotic continuation does not reduce infectious complications after elective pediatric ostomy...

The optimal duration of perioperative antibiotic prophylaxis for elective ostomy reversal in children remains unclear, and antibiotic regimens vary widely despite limited evidence supporting extended use. This study evaluated whether continuation of perioperative antibiotics beyond surgery completion reduces postoperative infectious complications in pediatric ostomy reversal.

A retrospective cohort study used the NSQIP Pediatric database and Surgical Antibiotic Prophylaxis files from 2021 to 2023. Children <18 years undergoing elective ostomy reversal were identified by CPT codes 44620, 44625, and 44626. Exclusion criteria included immunodeficiency, transplantation, malignancy, age <28 days, outpatient surgery, and missing antibiotic data. Patients were categorized as receiving antibiotics intraoperatively only versus postoperative continuation. The primary outcome was wound infection (superficial, deep, organ/space); secondary outcomes included pneumonia, UTI, length of stay, and days to discharge.

Of 2064 patients (median age 331 days), 60.4% continued antibiotics postoperatively. On multivariate analysis, postoperative antibiotic continuation was not associated with reduced wound infection. Higher preoperative albumin was protective against wound infection. No differences were observed in infection subtypes, UTI, pneumonia, or length of stay. Among children <1-year, antibiotic continuation was not protective, while term birth was associated with increased wound infection risk (OR 2.63, 95% CI 1.24-5.65).

Postoperative antibiotic continuation was not associated with reduced infectious complications following pediatric ostomy reversal. Preoperative nutritional optimization may play a greater role in reducing SSI than postoperative antibiotic continuation.