Antibiotic prophylaxis for the prevention of fistulae in cleft palate repair: A quality improvement study

Abstract

Background: Post-operative infection following cleft palate repair can lead to wound dehiscence and subsequent fistula formation. To prevent this, many surgeons advocate using post-operative antibiotic prophylaxis. The use of antibiotics in children is not without risks and with limited published data and variability both countrywide and in our unit, we wanted to address this research question.

Objective: To assess fistula rates and whether the provision of antibiotics post-operatively affected the incidence of oronasal fistula formation in patients with cleft palate.

Methodology: We performed an institutional retrospective study using data from patients undergoing primary palatoplasty between August 2021 and August 2022. These patients were divided into 2 groups. Group A included patients who received antibiotics only on induction and Group B additionally received post-operative antibiotic prophylaxis for 7 days. All participants (97) were evaluated for incidence of post-operative fistula formation.

Results: There was no evidence to suggest a difference in the fistula rate between the different timings of antibiotic regimen in Cycle 1; on induction + 2 intravenous doses (Group A) P = 0.807 and 7 days post-operatively (Group B) P = 0.820. Also, in cycle 2 there was no difference in the fistula rates between the 2 groups; P = 0.546 for Group A and P = 0.571 for Group B.

Conclusion: Our study suggests that the use of antibiotics post-operatively does not influence the formation of post-operative fistulae in cleft palate. This calls for a national randomised controlled study to answer this research question and achieve standardisation of practice.

Keywords: Antibiotic prophylaxis; Cleft palate; Oronasal fistulae.

Figure 1

Results from Cycle 1.

Figure 2

Results from Cycle 2.