Antibiotic Prophylaxis Use and Outcomes in Children Undergoing Laparoscopic Orchiopexy.

Abstract

We compared clinically relevant outcomes in children undergoing laparoscopic orchiopexy who did and did not receive antimicrobial prophylaxis. 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. 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; <i>P</i> = .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). 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.