Antibiotic Prophylaxis Use and Outcomes in Children Undergoing Laparoscopic Orchiopexy

Abstract

Purpose: To compare clinically relevant outcomes in children undergoing laparoscopic orchiopexy who did and did not receive antimicrobial prophylaxis.

Materials and methods: This was a multicenter cohort study using data from 144 National Surgical Quality Improvement Program-Pediatric hospitals. Patients younger than 18 years who underwent laparoscopic orchiopexy from January 1, 2021, to December 31, 2023, were included. Complementary hospital and patient-level analyses were performed to explore the relationship between prophylaxis and 30-day postoperative surgical site infection (SSI) rates. In the patient-level analysis, propensity score matching was used to balance groups on patient and procedural characteristics. The hospital-level analysis explored the correlation between prophylaxis and observed to expected SSI rate ratios after adjusting for patient and procedural characteristics.

Results: A total of 2739 children met inclusion criteria of whom 57% received prophylaxis. Outcomes were similar for SSIs in the patient-level analysis, including 2066 patients (prophylaxis: 13/1033 [1.3%] vs no prophylaxis: 13/1033 [1.3%]; adjusted odds ratio [aOR], 0.79; 95% CI, 0.30-2.11), and no correlation was found between rates of prophylaxis and SSIs in the hospital-level analysis (Spearman ρ = -0.081; P = .3). Outcomes were similar between groups in the patient-level analysis for reoperation (prophylaxis: 5/1033 [0.48%] vs no prophylaxis: 7/1033 [0.68%]; aOR, 0.86; 95% CI, 0.22-3.45) and readmission (prophylaxis: 6/1033 [0.58%] vs no prophylaxis: 10/1033 [1.0%]; aOR, 0.72; 95% CI, 0.23-2.32).

Conclusions: This study does not find significant evidence to support the association between the routine use of antimicrobial prophylaxis and improved outcomes in children undergoing laparoscopic orchiopexy.