Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair
Background:. There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affe...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-02-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005589 |
| _version_ | 1827339519280545792 |
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| author | Alex Davies, MBChB, FRCS(Plast) Amy Davies, MSc Barry Main, PhD, MFDS, FRCS(OMFS) Yvonne Wren, MEd, PhD, CertMRCSLT Scott Deacon, MOrth, MDTFEd, FDS(Orth) Alistair Cobb, FRCS(OMFS), FDSRCS(Eng), MFSEM(UK) Neil McLean, BSc, MD, FRCS David David, AC, MD, FRACS Shaheel Chummun, MBBS, MASurg(Cranio), FRCS(Plast) |
| author_facet | Alex Davies, MBChB, FRCS(Plast) Amy Davies, MSc Barry Main, PhD, MFDS, FRCS(OMFS) Yvonne Wren, MEd, PhD, CertMRCSLT Scott Deacon, MOrth, MDTFEd, FDS(Orth) Alistair Cobb, FRCS(OMFS), FDSRCS(Eng), MFSEM(UK) Neil McLean, BSc, MD, FRCS David David, AC, MD, FRACS Shaheel Chummun, MBBS, MASurg(Cranio), FRCS(Plast) |
| author_sort | Alex Davies, MBChB, FRCS(Plast) |
| collection | DOAJ |
| description | Background:. There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae.
Methods:. The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula.
Results:. Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics: OR 1.36; 95% confidence interval, 0.53–3.51; antibiotics up to 7 days postoperatively: OR 0.68; 95% confidence interval, 0.26–1.80).
Conclusions:. The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials. |
| first_indexed | 2024-03-07T20:01:51Z |
| format | Article |
| id | doaj.art-24aec77638d24e1889635c37c2a9f48a |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-03-07T20:01:51Z |
| publishDate | 2024-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-24aec77638d24e1889635c37c2a9f48a2024-02-28T06:48:00ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-02-01122e558910.1097/GOX.0000000000005589202402000-00020Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate RepairAlex Davies, MBChB, FRCS(Plast)0Amy Davies, MSc1Barry Main, PhD, MFDS, FRCS(OMFS)2Yvonne Wren, MEd, PhD, CertMRCSLT3Scott Deacon, MOrth, MDTFEd, FDS(Orth)4Alistair Cobb, FRCS(OMFS), FDSRCS(Eng), MFSEM(UK)5Neil McLean, BSc, MD, FRCS6David David, AC, MD, FRACS7Shaheel Chummun, MBBS, MASurg(Cranio), FRCS(Plast)8From the * South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom† The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom‡ Bristol Dental School, University of Bristol, Bristol, United Kingdom† The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United KingdomFrom the * South West Cleft Service, Bristol Dental Hospital, Bristol, United KingdomFrom the * South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom¶ Craniofacial Australia, North Adelaide, Australia.¶ Craniofacial Australia, North Adelaide, Australia.From the * South West Cleft Service, Bristol Dental Hospital, Bristol, United KingdomBackground:. There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae. Methods:. The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula. Results:. Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics: OR 1.36; 95% confidence interval, 0.53–3.51; antibiotics up to 7 days postoperatively: OR 0.68; 95% confidence interval, 0.26–1.80). Conclusions:. The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005589 |
| spellingShingle | Alex Davies, MBChB, FRCS(Plast) Amy Davies, MSc Barry Main, PhD, MFDS, FRCS(OMFS) Yvonne Wren, MEd, PhD, CertMRCSLT Scott Deacon, MOrth, MDTFEd, FDS(Orth) Alistair Cobb, FRCS(OMFS), FDSRCS(Eng), MFSEM(UK) Neil McLean, BSc, MD, FRCS David David, AC, MD, FRACS Shaheel Chummun, MBBS, MASurg(Cranio), FRCS(Plast) Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair Plastic and Reconstructive Surgery, Global Open |
| title | Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair |
| title_full | Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair |
| title_fullStr | Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair |
| title_full_unstemmed | Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair |
| title_short | Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair |
| title_sort | association of perioperative antibiotics with the prevention of postoperative fistula after cleft palate repair |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005589 |
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