Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Patel, Priyesh N.; Jayawardena, Asitha D L; Walden, Rachel; Penn, Edward B.; Francis, David O.

doi:10.1177/0194599817753610

Cited by 67 publications

(101 citation statements)

References 187 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall SSI rate of this study (0.12%) compares favorably to clean head and neck procedures such as thyroidectomy . It is, therefore, reasonable to recommend against the routine use of PAs in DML, similar to clean head and neck procedures and other clean‐contaminated procedures with low incidence of SSIs, such as tonsillectomy and septoplasty …”

Section: Discussionmentioning

confidence: 74%

“…The sole clinical practice guideline in otolaryngology–head and neck surgery regarding the use of PAs exists for tonsillectomy, also a clean‐contaminated case, in which the use of PAs is not recommended . Patel et al, in a state of the art review, investigated evidence‐based use of PAs in otolaryngology . They found that PAs were justified in complex septorhinoplasty, skull base surgery, and clean‐contaminated head and neck surgery such as oral cavity resection and laryngectomy without free flaps .…”

Section: Discussionmentioning

confidence: 99%

“…Patel et al, in a state of the art review, investigated evidence‐based use of PAs in otolaryngology . They found that PAs were justified in complex septorhinoplasty, skull base surgery, and clean‐contaminated head and neck surgery such as oral cavity resection and laryngectomy without free flaps . They recommended against PAs in other clean‐contaminated procedures such as tonsillectomy, sinus surgery, and septoplasty .…”

Section: Discussionmentioning

confidence: 99%

“…They found that PAs were justified in complex septorhinoplasty, skull base surgery, and clean‐contaminated head and neck surgery such as oral cavity resection and laryngectomy without free flaps . They recommended against PAs in other clean‐contaminated procedures such as tonsillectomy, sinus surgery, and septoplasty . Studies evaluating the role of PAs in clean‐contaminated head and neck surgery have mostly focused on open surgeries such as laryngectomy and oral cavity/oropharyngeal cancer resections, with or without free flap surgery, where SSI rates range from 3% to 51% .…”

Section: Discussionmentioning

confidence: 99%

“…They recommended against PAs in other clean‐contaminated procedures such as tonsillectomy, sinus surgery, and septoplasty . Studies evaluating the role of PAs in clean‐contaminated head and neck surgery have mostly focused on open surgeries such as laryngectomy and oral cavity/oropharyngeal cancer resections, with or without free flap surgery, where SSI rates range from 3% to 51% . Though DML falls under the category of clean‐contaminated head and neck surgery, it is clearly a different surgical entity requiring separate analysis.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

et al. 2018

View full text Add to dashboard Cite

Objectives/Hypothesis There are currently no established recommendations for the use of perioperative antibiotics (PAs) to prevent surgical site infections (SSIs) for direct microlaryngoscopy (DML). This study examined the incidence of SSI in patients undergoing DML with and without PAs. Study Design Retrospective, multi‐institutional chart review. Methods A retrospective, multi‐institutional chart review was performed at four tertiary referral academic medical centers. Patients undergoing DML from 2010 to 2017 were identified using Current Procedural Terminology codes. Medical records of patients undergoing DML with biopsy, microsurgery, laser ablation, or vocal fold injection who had adequate follow‐up were reviewed. Procedures with significant cartilage destruction, concurrent open surgery, or esophageal surgery were excluded. Data recorded included age, gender, pacemaker history, American Society of Anesthesiologists class, wound class, indication for surgery, use of laser, complications, emergency room visits, hospitalizations, pain, fever, and postoperative steroid and antibiotic prescriptions. Presence or absence of SSIs was evaluated by a fellowship‐trained laryngologist. Results There were 834 patients who met inclusion criteria. Of those, 698 did not receive PAs and 136 received PAs. The median age of patients was 54 years of age in the PA group and 57.5 years of age in the non‐PA group, and all cases were recorded as wound class II. Overall, 58% of surgeries involved use of carbon dioxide or potassium‐titanyl‐phosphate laser. Only one SSI was reported on follow‐up in a patient who did receive PAs. Conclusions SSIs are exceedingly rare following DML. PA use is not indicated for routine DML. Level of Evidence 4 Laryngoscope, 128:2838–2843, 2018

show abstract

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

et al. 2018

View full text Add to dashboard Cite

show abstract

Antibiotic prophylaxis in anterior skull‐base surgery: a survey of the North American Skull Base Society

Fang

Hawn

Agarwal

et al. 2019

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Introduction: There is a paucity of data evaluating antibiotic use in anterior skull base surgery (ASBS). The goal of this study was to determine antibiotic prescribing patterns and factors that influence antibiotic use in ASBS.Methods: An online-based survey was distributed to the membership of the North American Skull Base Society in 2018. Outcomes included practitioner preference regarding intra-and postoperative antibiotic use, practice location and environment, surgeon experience, and patient factors influencing antibiotic use.

show abstract

Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double‐blind, placebo‐controlled noninferiority clinical trial

Lehmann

Raquib

Siddiqi

et al. 2020

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background Surgeons commonly prescribe prophylactic antibiotics after endoscopic sinus surgery (ESS), yet minimal data exist to support this practice. In this study we aimed to assess the impact of post‐ESS antibiotics on infection, quality of life (QOL), and endoscopic scores. Methods This was a randomized, double‐blind, placebo‐controlled, noninferiority trial comparing amoxicillin‐clavulanate vs placebo after ESS (NCT01919411, ClinicalTrials.gov). Adults (N = 77) with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS were randomized to antibiotics (N = 37) or placebo (N = 40) and followed clinically (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9 weeks postoperatively). At baseline and follow‐up, QOL was measured with 22‐item Sino‐Nasal Outcome Test questionnaires and Lund‐Kennedy endoscopic scores were evaluated. Outcomes were analyzed with repeated‐measures analysis of variance and analysis of covariance and z tests for proportions. Results Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT‐22 scores (β = 0.18, 2‐tailed p < 0.05). There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time (p = 0.63) or in postoperative infection rates (2.6% vs 2.4%, respectively; p = 0.96). The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8; p = 0.02). Conclusion Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal‐specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group. These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post‐ESS and significantly increases the rate of diarrhea.

show abstract

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Cited by 67 publications

References 187 publications

Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

Antibiotic prophylaxis in anterior skull‐base surgery: a survey of the North American Skull Base Society

Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double‐blind, placebo‐controlled noninferiority clinical trial

Contact Info

Product

Resources

About