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Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery.

Publication ,  Journal Article
He, K; Nayak, RB; Allori, AC; Brighton, BK; Cina, RA; Ellison, JS; Goretsky, MJ; Jatana, KR; Proctor, MR; Grant, C; Thompson, VM; Iwaniuk, M ...
Published in: JAMA Surg
December 1, 2022

IMPORTANCE: Use of postoperative antimicrobial prophylaxis is common in pediatric surgery despite consensus guidelines recommending discontinuation following incision closure. The association between postoperative prophylaxis use and surgical site infection (SSI) in children undergoing surgical procedures remains poorly characterized. OBJECTIVE: To evaluate whether use of postoperative surgical prophylaxis is correlated with SSI rates in children undergoing nonemergent surgery. DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter cohort study using 30-day postoperative SSI data from the American College of Surgeons' Pediatric National Surgical Quality Improvement Program (ACS NSQIP-Pediatric) augmented with antibiotic-use data obtained through supplemental medical record review from June 2019 to June 2021. This study took place at 93 hospitals participating in the ACS NSQIP-Pediatric Surgical Antibiotic Prophylaxis Stewardship Collaborative. Participants were children (<18 years of age) undergoing nonemergent surgical procedures. Exclusion criteria included antibiotic allergies, conditions associated with impaired immune function, and preexisting infections requiring intravenous antibiotics at time of surgery. EXPOSURES: Continuation of antimicrobial prophylaxis beyond time of incision closure. MAIN OUTCOMES AND MEASURES: Thirty-day postoperative rate of incisional or organ space SSI. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for SSI rates and postoperative prophylaxis use. SSI measures were adjusted for differences in procedure mix, patient characteristics, and comorbidity profiles, while use measures were adjusted for clinically related procedure groups. Pearson correlations were used to examine the associations between hospital-level postoperative prophylaxis use and SSI measures. RESULTS: Forty thousand six hundred eleven patients (47.3% female; median age, 7 years) were included, of which 41.6% received postoperative prophylaxis (hospital range, 0%-71.2%). Odds ratios (ORs) for postoperative prophylaxis use ranged 190-fold across hospitals (OR, 0.10-19.30) and ORs for SSI rates ranged 4-fold (OR, 0.55-1.90). No correlation was found between use of postoperative prophylaxis and SSI rates overall (r = 0.13; P = .20), and when stratified by SSI type (incisional SSI, r = 0.08; P = .43 and organ space SSI, r = 0.13; P = .23), and surgical specialty (general surgery, r = 0.02; P = .83; urology, r = 0.05; P = .64; plastic surgery, r = 0.11; P = .35; otolaryngology, r = -0.13; P = .25; orthopedic surgery, r = 0.05; P = .61; and neurosurgery, r = 0.02; P = .85). CONCLUSIONS AND RELEVANCE: Use of postoperative surgical antimicrobial prophylaxis was not correlated with SSI rates at the hospital level after adjusting for differences in procedure mix and patient characteristics.

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Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

December 1, 2022

Volume

157

Issue

12

Start / End Page

1142 / 1151

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Risk Factors
  • Retrospective Studies
  • Male
  • Humans
  • Female
  • Cohort Studies
  • Child
  • Antibiotic Prophylaxis
  • Anti-Infective Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
He, K., Nayak, R. B., Allori, A. C., Brighton, B. K., Cina, R. A., Ellison, J. S., … Rangel, S. J. (2022). Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery. JAMA Surg, 157(12), 1142–1151. https://doi.org/10.1001/jamasurg.2022.4729
He, Katherine, Raageswari B. Nayak, Alexander C. Allori, Brian K. Brighton, Robert A. Cina, Jonathan S. Ellison, Michael J. Goretsky, et al. “Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery.JAMA Surg 157, no. 12 (December 1, 2022): 1142–51. https://doi.org/10.1001/jamasurg.2022.4729.
He K, Nayak RB, Allori AC, Brighton BK, Cina RA, Ellison JS, et al. Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery. JAMA Surg. 2022 Dec 1;157(12):1142–51.
He, Katherine, et al. “Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery.JAMA Surg, vol. 157, no. 12, Dec. 2022, pp. 1142–51. Pubmed, doi:10.1001/jamasurg.2022.4729.
He K, Nayak RB, Allori AC, Brighton BK, Cina RA, Ellison JS, Goretsky MJ, Jatana KR, Proctor MR, Grant C, Thompson VM, Iwaniuk M, Cohen ME, Saito JM, Hall BL, Newland JG, Ko CY, Rangel SJ. Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery. JAMA Surg. 2022 Dec 1;157(12):1142–1151.

Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

December 1, 2022

Volume

157

Issue

12

Start / End Page

1142 / 1151

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Risk Factors
  • Retrospective Studies
  • Male
  • Humans
  • Female
  • Cohort Studies
  • Child
  • Antibiotic Prophylaxis
  • Anti-Infective Agents