Laryngectomy complications are associated with perioperative antibiotic choice

Alexander Langerman, Sandra A. Ham, Jennifer Pisano, Joseph Pariser, Samuel F. Hohmann, David O. Meltzer

Research output: Contribution to journalArticle

20 Citations (Scopus)

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 costeffective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin-allergic patients.

Original languageEnglish (US)
Pages (from-to)60-68
Number of pages9
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume153
Issue number1
DOIs
StatePublished - Jul 3 2015

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Laryngectomy
Anti-Bacterial Agents
Clindamycin
Surgical Wound Infection
Odds Ratio
Confidence Intervals
Logistic Models
High-Volume Hospitals
Physicians
Cefazolin
Metronidazole
Wounds and Injuries
Ambulatory Surgical Procedures
Penicillins
Clinical Trials

Keywords

  • antibiotics
  • clindamycin
  • laryngectomy
  • surgical site infection

Cite this

Laryngectomy complications are associated with perioperative antibiotic choice. / Langerman, Alexander; Ham, Sandra A.; Pisano, Jennifer; Pariser, Joseph; Hohmann, Samuel F.; Meltzer, David O.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 153, No. 1, 03.07.2015, p. 60-68.

Research output: Contribution to journalArticle

Langerman, Alexander ; Ham, Sandra A. ; Pisano, Jennifer ; Pariser, Joseph ; Hohmann, Samuel F. ; Meltzer, David O. / Laryngectomy complications are associated with perioperative antibiotic choice. In: Otolaryngology - Head and Neck Surgery (United States). 2015 ; Vol. 153, No. 1. pp. 60-68.
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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 costeffective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin-allergic patients.",
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AU - Meltzer, David O.

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AB - 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 costeffective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin-allergic patients.

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