Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

Abstract

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

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

“…Our findings are supported by a recent multi‐institutional study by Yetzke et al, which evaluated the efficacy of one‐time perioperative antibiotics prior to surgical incision in the prevention of SSI in phonomicrosurgery and demonstrated no difference in SSI rates . Interestingly, they found an overall SSI rate of only 0.12%, which is lower than the overall SSI rate in most clean‐contaminated cases and also lower than the 3.2% rate of SSI found in our study .…”

“…The Centers for Disease Control (CDC) has stated that perioperative antibiotic prophylaxis is not indicated for clean, nonprosthetic‐associated procedures, as defined by international guidelines . More recently, the CDC has moved away from recommending perioperative antibiotic prophylaxis for all clean‐contaminated procedures, including those on the aerodigestive tract, to “only when indicated based on clinical practice guidelines.” Unfortunately, there are no clinical practice guidelines for laryngeal procedures for benign diseases . Further, in the updated 2017 recommendations, the CDC recommends against the use of postoperative antibiotics in clean and clean‐contaminated procedures.…”

“…Isolated case reports have documented bacteremia and sepsis after endotracheal intubation and endolaryngeal surgery . Currently, some surgeons use antibiotics routinely after phonomicrosurgery and open phonosurgery, whereas others use postoperative antibiotics only when the operative site is infected …”

Rethinking Perioperative Antibiotic Prophylaxis for Low-Risk Head and Neck Procedures

“…7 Additionally, two studies examining a range of direct laryngoscopy and microlaryngoscopy procedures have shown no significant difference in SSI related to presence or absence of perioperative antibiotic use. 8,9 Our analysis demonstrated inconsistency at our institution between best practice guidelines and perioperative antibiotic use in low-risk head and neck procedures. Almost one-third of these patients received unnecessary perioperative antibiotics.…”

“…5,6 However, there are certain otolaryngology (ENT) procedures with low surgical site infection (SSI) risk for which there is negligible benefit from perioperative antibiotic administration. [7][8][9] The objective of this evaluation was to describe antibiotic use and adherence to best practices in lowrisk head and neck procedures for which antibiotic prophylaxis is not indicated within our institution.…”