Katherine H. Chan

Variation in Surgical Antibiotic Prophylaxis for Outpatient Pediatric Urological Procedures at United States Children’s Hospitals

Purpose: Guidelines recommend surgical antibiotic prophylaxis for clean‐contaminated procedures but none for clean procedures. The purpose of this study was to describe variations in surgical antibiotic prophylaxis for outpatient urological procedures at United States children’s hospitals. Materials and Methods: Using the PHIS (Pediatric Health Information System®) database we performed a retrospective cohort study of patients younger than 18 years who underwent clean and/or clean‐contaminated outpatient urological procedures from 2012 to 2014. We excluded those with concurrent nonurological procedures or an abscess/infected wound. We compared perioperative antibiotic charges for clean vs clean‐contaminated procedures using a multilevel logistic regression model with a random effect for hospital. We also examined whether hospitals that were guideline compliant for clean procedures, defined as no surgical antibiotic prophylaxis, were also compliant for clean‐contaminated procedures using the Pearson correlation coefficient. We examined hospital level variation in antibiotic rates using the coefficient of variation. Results: A total of 131,256 patients with a median age of 34 months at 39 hospitals met study inclusion criteria. Patients undergoing clean procedures were 14% less likely to receive guideline compliant surgical antibiotic prophylaxis than patients undergoing clean‐contaminated procedures (OR 0.86, 95% CI 0.84–0.88, p <0.0001). Hospitals that used antibiotics appropriately for clean‐contaminated procedures were more likely to use antibiotics inappropriately for clean procedures (r = 0.7, p = 0.01). Greater variation was seen for hospital level compliance with surgical antibiotic prophylaxis for clean‐contaminated procedures (range 9.8% to 97.8%, coefficient of variation 0.36) than for clean procedures (range 35.0% to 98.2%, coefficient of variation 0.20). Conclusions: Hospitals that used surgical antibiotic prophylaxis appropriately for clean‐contaminated procedures were likely to use surgical antibiotic prophylaxis inappropriately for clean procedures. More variation was seen in hospital level guideline compliance for clean‐contaminated procedures.

MP66-06 IS SURGICAL ANTIBIOTIC PROPHYLAXIS NECESSARY FOR PEDIATRIC ORCHIOPEXY?

INTRODUCTION AND OBJECTIVES: Surgeons frequently use surgical antibiotic prophylaxis (SAP) despite limited evidence to support its efficacy. We hypothesized that children who received SAP prior to orchiopexy would have no reduction in surgical site infection (SSI) risk but an increased risk of antibiotic-associated adverse events. METHODS: We performed a retrospective cohort study of all males between 30 days and 18 years of age who underwent an orchiopexy (ICD-9 CM 62.5) with or without herniorraphy (ICD-9 CM 53.0 or 53.1) in an ambulatory or observation setting from January 2004 to December 2015 using the Pediatric Health Information System database. We excluded inpatients and those with any concomitant procedures. We used Chi-square or Fisher’s exact tests to determine the association between SAP and allergic reaction (defined as a charge for epinephrine or ICD-9 diagnosis code for allergic reaction on the date of surgery) and any of the following within 30 days: SSI, hospital readmission or any repeat hospital encounter. We performed mixed effects logistic regression controlling for age, race, insurance and clustering of similar practice patterns by hospital. RESULTS: A total of 71,767 patients were included: median age 4.6 years; 61.4% white; 49.3% with public insurance. 33.5% received SAP. A total of 1.4% of patients had a perioperative allergic reaction and <0.1% of patients were diagnosed with a SSI. On mixed effects logistic regression, patients who received SAP had 1.2 times the odds of a perioperative allergic reaction compared to those who did not receive SAP (p1⁄40.005). SAP was not associated with SSI, hospital readmission, or any repeat encounter within 30 days. CONCLUSIONS: In patients undergoing orchiopexy we found that SAP did not reduce the risk of postoperative SSI, readmissions or hospital visits. Patients who received SAP, however, had significantly increased odds of perioperative allergic reaction. This suggests that the risks of SAP may outweigh the benefits in children undergoing orchiopexy.