(A952) Surgical Antibiotic Prophylaxis Utilization and Necessity in Pediatric Branchial Cleft Cyst Excision

Introduction: Branchial cleft cyst (BCC) excision encompasses a heterogenous group of pathologies with differential wound classifications and frequent use of prophylactic intravenous antibiotics (PIAB) to mitigate infection risk. This study examines the utilization and efficacy of PIAB in BCC-excision amid concerns of antibiotic stewardship.

Methods: The NSQIP-Pediatric 2021-2023 dataset was searched for patients (≤18) without acute infection or immune compromise who underwent BCC-excision. Multivariate regressions including clinicodemographic covariates (age, sex, race, setting, surgeon specialty, wound classification, comorbidities, CPT, ICD-10) and antibiotic usage were performed to assess outcomes including wound infections, unplanned readmissions, and reoperations.

Results: Of 2,944 patients identified, 2,005 received PIAB. Patients aged 0-2 years (OR, 0.55; 95% CI, 0.42-0.70; p< 0.001) and 2-5 years (0.65, 0.50-0.84, p=0.001) were significantly less likely to receive PIAB than older patients as were those cared for by non-otolaryngologists compared to otolaryngologists (0.70, 0.58-0.83, p< 0.001). Hispanic patients (1.39, 1.12-1.74, p=0.003), those with clean/contaminated wounds (1.31, 1.09-1.56, p=0.004), those admitted postoperatively (1.44, 1.02-2.07, p=0.042), and those with BCC depth “beneath subcutaneous tissue” (1.49, 1.26-1.76, p< 0.001) had increased odds of PIAB. PIAB did not have any significant effect on outcomes on univariate or multivariate analysis for the whole population or when stratified by CPT or ICD-10 code. However, on multivariate analysis “preauricular sinuses and cysts” had increased odds of postoperative infection (2.33, 1.33-4.10, p=0.003) regardless of PIAB.

Conclusions: PIAB was not shown to improve outcomes in pediatric BCC-cases and was variably employed depending on patient characteristics. These findings underscore the need to reevaluate the necessity of PIAB in BCC-excisions and to refine perioperative strategies; further, clarifying perioperative diagnoses in this heterogenous pathology is necessary for more nuanced research and guidelines.