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

Christina H. Fang, Vivian S. Hawn, Vijay Agarwal, Howard S. Moskowitz, Varun R. Kshettry, Erin L. McKean, Emily Bellile, Nadeem A. Akbar, Waleed M. Abuzeid

Research output: Contribution to journalArticle

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Abstract

Background: 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 intraoperative and postoperative antibiotic use, practice location and environment, surgeon experience, and patient factors influencing antibiotic use. Results: There were 208 respondents (25.6% response rate) of which 182 (87.5%) performed ASBS; 60.4% were in academic institutions. Respondents were neurosurgeons (59.3%) or otolaryngologists (40.7%), and 75.3% were fellowship-trained in ASBS. Most surgeons (95.0%) gave intraoperative antibiotics. Academic surgeons were 4 times more likely to prescribe intraoperative antibiotics than private practitioners (odds ratio [OR] 3.98; 95% confidence interval [CI], 1.53 to 10.36; p = 0.005). Among surgeons who did not routinely prescribe intraoperative antibiotics, regression analysis indicated that the presence of actively infected sinuses, transplantation, diabetes, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and pulmonary disease influenced decision-making (p < 0.03). Postoperative antibiotics were prescribed by 73.6% of respondents. European surgeons were 3 times less likely to prescribe postoperative antibiotics (OR 0.34; 95% CI, 0.15 to 0.80; p = 0.01). Regression modeling indicated that HIV/AIDS, cystic fibrosis, diabetes, transplantation, and pulmonary disease, as well as the use of absorbable packing influenced the decision to use postoperative antibiotics (p < 0.003). Conclusion: This study demonstrates the significant variation in intra- and postoperative antibiotic use among surgeons performing ASBS. Prospective randomized studies are necessary to establish evidence-based practice guidelines for perioperative antibiotic use in ASBS.

Original languageEnglish (US)
JournalInternational Forum of Allergy and Rhinology
DOIs
StateAccepted/In press - Jan 1 2019

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Antibiotic Prophylaxis
Skull Base
Anti-Bacterial Agents
Surveys and Questionnaires
Lung Diseases
Acquired Immunodeficiency Syndrome
Transplantation
Odds Ratio
HIV
Confidence Intervals
Evidence-Based Practice
Practice Guidelines
Cystic Fibrosis
Surgeons
Decision Making

Keywords

  • antibiotic prophylaxis
  • cerebrospinal fluid leak
  • meningitis
  • skull base
  • skull-base neoplasms
  • surveys and questionnaires

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Antibiotic prophylaxis in anterior skull-base surgery : a survey of the North American Skull Base Society. / Fang, Christina H.; Hawn, Vivian S.; Agarwal, Vijay; Moskowitz, Howard S.; Kshettry, Varun R.; McKean, Erin L.; Bellile, Emily; Akbar, Nadeem A.; Abuzeid, Waleed M.

In: International Forum of Allergy and Rhinology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: 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 intraoperative and postoperative antibiotic use, practice location and environment, surgeon experience, and patient factors influencing antibiotic use. Results: There were 208 respondents (25.6{\%} response rate) of which 182 (87.5{\%}) performed ASBS; 60.4{\%} were in academic institutions. Respondents were neurosurgeons (59.3{\%}) or otolaryngologists (40.7{\%}), and 75.3{\%} were fellowship-trained in ASBS. Most surgeons (95.0{\%}) gave intraoperative antibiotics. Academic surgeons were 4 times more likely to prescribe intraoperative antibiotics than private practitioners (odds ratio [OR] 3.98; 95{\%} confidence interval [CI], 1.53 to 10.36; p = 0.005). Among surgeons who did not routinely prescribe intraoperative antibiotics, regression analysis indicated that the presence of actively infected sinuses, transplantation, diabetes, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and pulmonary disease influenced decision-making (p < 0.03). Postoperative antibiotics were prescribed by 73.6{\%} of respondents. European surgeons were 3 times less likely to prescribe postoperative antibiotics (OR 0.34; 95{\%} CI, 0.15 to 0.80; p = 0.01). Regression modeling indicated that HIV/AIDS, cystic fibrosis, diabetes, transplantation, and pulmonary disease, as well as the use of absorbable packing influenced the decision to use postoperative antibiotics (p < 0.003). Conclusion: This study demonstrates the significant variation in intra- and postoperative antibiotic use among surgeons performing ASBS. Prospective randomized studies are necessary to establish evidence-based practice guidelines for perioperative antibiotic use in ASBS.",
keywords = "antibiotic prophylaxis, cerebrospinal fluid leak, meningitis, skull base, skull-base neoplasms, surveys and questionnaires",
author = "Fang, {Christina H.} and Hawn, {Vivian S.} and Vijay Agarwal and Moskowitz, {Howard S.} and Kshettry, {Varun R.} and McKean, {Erin L.} and Emily Bellile and Akbar, {Nadeem A.} and Abuzeid, {Waleed M.}",
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AU - Moskowitz, Howard S.

AU - Kshettry, Varun R.

AU - McKean, Erin L.

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KW - skull-base neoplasms

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