Reevaluating Surgical Antibiotic Prophylaxis in Pediatric Pyloromyotomy: Insights From the NSQIP-Pediatric Database.

BACKGROUND

Pyloromyotomy is a clean surgical procedure with a low risk of surgical site infections (SSIs). Despite this, surgical antibiotic prophylaxis (SAP) is often administered, raising concerns about unnecessary antibiotic exposure and antimicrobial resistance. This study aims to evaluate whether SAP reduces SSI rates in infants undergoing pyloromyotomy for hypertrophic pyloric stenosis and to propose a guideline for selective SAP omission.

METHODS

This retrospective cohort study analyzed data from the National Surgical Quality Improvement Program-Pediatric database. Infants undergoing pyloromyotomy between January 1, 2021 and December 31, 2023 were included. The primary outcome was the occurrence of SSIs within 30 days postoperatively. Secondary outcomes included stratified rates of superficial, deep incisional, and organ/space SSIs.

RESULTS

Among 4917 infants (age <1 year; 84.26 % male), 49.48 % received SAP. Additionally, 81 patients (1.65 %) received post-operative antibiotics beyond the intraoperative period. The overall SSI rate was 1.42 %, primarily comprised of superficial SSIs. There was no significant difference in SSI rates between infants receiving SAP (1.15 %) and those not receiving SAP (1.69 %) (p = 0.110). The rate of unplanned readmission and unplanned return to the operating room within 30 days was 2.44 % and 1.04 %, respectively, with no significant difference between those who received post-operative antibiotics and those who did not (p > 0.2 for both comparisons).

CONCLUSIONS

Routine SAP administration in pyloromyotomy is unnecessary given the low risk of SSIs. SAP in ASA Class I or II infants undergoing isolated pyloromyotomy without mucosal perforation, immune-compromising conditions, infections, or trauma should be omitted. These findings support efforts to optimize antibiotic stewardship in pediatric surgical practice.

TYPE OF STUDY: Original Research Article.

LEVEL OF EVIDENCE: III.