Optimization of Delivery of Pediatric Otolaryngology Surgical Antibiotic Prophylaxis.

Abstract

There is limited evidence regarding use of routine perioperative antibiotics for pediatric otolaryngologic procedures. The objectives of this quality improvement study were (1) to characterize the otolaryngology case mix for which antibiotics were delivered and (2) determine the percentage of surgical encounters with appropriate timing of antibiotic administration. Pediatric otolaryngology procedures meeting criteria from 2015 to 2019 were evaluated as a component of an institution-wide pediatric surgical antibiotic prophylaxis study using A3 problem solving to identify and roll out interventions for appropriate antibiotic administration. Descriptive statistical analysis of the interrupted time-series data was used to describe the otolaryngology case mix for which antibiotics were delivered. The primary outcome measure was percentage of surgical encounters with appropriate timing of antibiotic administration in minutes relative to incision. In total, 1520 pediatric otolaryngology procedures with perioperative antibiotic delivery were performed from July 2015 to September 2019. While surgical site infection number (n = 2/year) was stable, administration of timely prophylactic antibiotics significantly improved: 27.5% of cases per month at baseline and 86.9% at the conclusion of the rollout of the sequential interventions (P < .001). Given the exceedingly low infection rate of clean otolaryngology surgery, there is limited evidence in favor of perioperative antibiotics for the majority of procedures. Prophylactic antibiotics were most commonly used in otologic surgery involving cochlear implantation or in the setting of draining ears or cholesteatoma and in clean-contaminated head and neck surgery cases. Iterative continuous performance improvement can optimize evidence-based delivery of preoperative prophylactic antibiotics. Additional interventions to ensure antimicrobial stewardship in pediatric otolaryngology are indicated.