Infection Rates After Microlaryngeal and Open Phonosurgery: The Role of Postoperative Antibiotics

Abstract

Objective: Although it is known that the airway has bacterial contamination that seeds the surgical site during microlaryngeal surgery, literature on the use of postoperative antibiotics is lacking. We performed a retrospective analysis of open phonosurgical and phonomicrosurgical cases at a single institution to assess whether use of postoperative antibiotics impacts the incidence of surgical site infections (SSI).Methods: In this retrospective cohort study, we reviewed 228 phonomicrosurgery and 53 open phonosurgery cases performed for benign diseases. Surgeries were performed by two laryngologists between February 2016 and August 2018. The surgeons differ in their postoperative antibiotic regimens: no antibiotics versus a 5-to 7-day postoperative course.Data collected include demographics, medical comorbidities, type of benign laryngeal disease, and surgical procedure. The primary outcome measure was postoperative infection, defined as the patient requiring a new prescription for antibiotics, an extended course of antibiotics, or any mention of infection at follow-up/emergency visits within the first month postoperatively.Results: The overall rate of SSI was 3.1% and 0% for phonomicrosurgery and open phonosurgery cases, respectively. For phonomicrosurgery, there was no difference in the rate of SSI for patients who received or did not receive antibiotics perioperatively: 2.9% versus 3.2% (P = 0.99). Similarly, there was no difference in the infection rate for open phonosurgical cases.Conclusion: Infection rates after endoscopic and open phonosurgery are low. In this study, we found no evidence to suggest a protective effect associated with postoperative use of antibiotics.

Surgical wound classification in otolaryngology: A state‐of‐the‐art review

“…In Otolaryngology, the risk for SSI has been found to be low in nonmajor surgery and endocrine surgery including thyroidectomy 13 . However, this risk is significantly increased with all major surgery involving nearly any anatomical subsite of the head and neck, including the aerodigestive tract, paranasal sinuses, ear, salivary glands, larynx, or facial bones 13,42 …”

“…13 However, this risk is significantly increased with all major surgery involving nearly any anatomical subsite of the head and neck, including the aerodigestive tract, paranasal sinuses, ear, salivary glands, larynx, or facial bones. 13,42 A number of national organizations have made efforts to measure and report SSI toward the goal of improving surgical quality.…”

Principles of Phonosurgery

“…Intraoperative antibiotics are not required for phonosurgical procedures and do not have an impact on postoperative infection rates. 8 Avoidance of vigorous coughing with extubation is particularly important for phonosurgical procedures. Application of 4% topical lidocaine prior to removal of the laryngoscope can help with this, and consideration of a deep extubation if the patient can be easily bag-mask ventilated and exposed is warranted.…”

The Effect of Platelet-Rich Plasma Injection on Short Term Vocal Outcomes Following Phonosurgery—A Pilot Study

“…Another matter of concern could be that voice rest as a part of sick leave alone might outweigh the financial burden of the surgery itself [ 3 ]. Adjuvant medical treatment options following surgery, such as antibiotics or proton pump inhibitors, do not seem to benefit patients in terms of healing time and voice outcomes [ 5 , 6 , 7 ].…”