NDLI: Laryngectomy Complications Are Associated with Perioperative Antibiotic Choice.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Langerman, Alexander Ham, Sandra A. Pisano, Jennifer Pariser, Joseph Hohmann, Samuel F. Meltzer, David O.
Spatial Coverage	United States
Description	Author Affiliation: Langerman A ( Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA Operative Performance Research Institute, University of Chicago Medicine, Chicago, Illinois, USA Center for Health and the Social Sciences, University of Chicago Medicine, C); Ham SA ( Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois, USA.); Pisano J ( Section of Infectious Diseases, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.); Pariser J ( Operative Performance Research Institute, University of Chicago Medicine, Chicago, Illinois, USA Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA.); Hohmann SF ( University HealthSystem Consortium, Chicago, Illinois, USA.); Meltzer DO ( Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois, USA Hospital Medicine, University of Chicago Medicine, Chicago, Illinois, USA.)
Abstract	OBJECTIVE: To assess hospital- and physician-level variation in pattern of perioperative antibiotic use for laryngectomy and the relationship between pattern of antibiotic use and surgical site infection (SSI), wound dehiscence, and antibiotic-induced complications. STUDY DESIGN: Retrospective analysis of University HealthSystem Consortium data. SETTING: Academic medical centers and affiliated hospitals. SUBJECTS AND METHODS: Elective admissions for laryngectomy from 2008 to 2011 and associated 30-day readmissions were analyzed with multivariate logistic regression models. RESULTS: There were 439 unique antibiotic regimens (agents and duration) identified over the first 4 days of the 1865 admissions included in this study. Ampicillin/sulbactam, cefazolin + metronidazole, and clindamycin were the most common agents given on the day of surgery. Clindamycin was independently associated with higher odds of SSI (odds ratio [OR] = 3.87, 95% confidence interval [CI] = 2.31-6.49]), wound dehiscence (OR = 3.42, 95% CI = 2.07-5.64), and antibiotic-induced complications (OR = 3.01, 95% CI = 1.59-5.67) when given alone; it was also associated with higher odds of SSI (OR = 2.69, 95% CI = 1.43-5.05) and antibiotic-induced complications (OR = 2.20, 95% CI = 1.04-4.64) when given with other agents. These effects were stronger in a subsample of high-volume physicians and hospitals. CONCLUSION: There is substantial variability in perioperative antibiotic strategies for laryngectomy. Clindamycin was associated with much higher odds of short-term complications as compared to other common regimens. Based on these data, clinical trials should be planned to firmly establish the most effective and cost-effective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin-allergic patients.
File Format	HTM / HTML
ISSN	01945998
Issue Number	1
Volume Number	153
e-ISSN	10976817
Journal	Otolaryngology -- Head and Neck Surgery
Language	English
Publisher	SAGE Publications
Publisher Date	2015-07-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Research Support, Non-u.s. Gov't Adverse Effects Laryngeal Neoplasms United States Humans Middle Aged Risk Factors Discipline Otolaryngology Male Antibiotic Prophylaxis Administration & Dosage Surgical Wound Infection Laryngectomy Epidemiology Anti-bacterial Agents Journal Article Physician's Practice Patterns Surgery Adult Female Aged Retrospective Studies Surgical Wound Dehiscence
Content Type	Text
Resource Type	Article
Subject	Otorhinolaryngology Surgery

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