Association of surgical antibiotic prophylaxis with postoperative outcomes following pediatric gastrostomy tube placement: A propensity score overlap weighted analysis.

BACKGROUND

Surgical antimicrobial prophylaxis (SAP) before gastrostomy tube placement is supported by guidelines but evidence regarding its efficacy in preventing surgical site infections (SSIs) in children is conflicting and largely extrapolated from adult data. This study aims to analyze the association between SAP and postoperative outcomes in children undergoing G-Tube placement.

METHODS

We conducted a retrospective multicenter cohort study using the ACS NSQIP-Pediatric database (2021-2024) to identify children undergoing gastrostomy tube insertion. Patients with contaminated/dirty wound classifications or concurrent surgeries were excluded. The primary exposure was preoperative SAP, and propensity score overlap weighting was utilized to balance covariates like race, age, and ASA classification to estimate the association between SAP and 30-day SSI, unplanned readmission, and reoperation. Associations after overlap weighting were reported as adjusted odds ratio (AOR) while baseline comparisons were done using Wilcoxon rank sum test, Chi-squared test and Fisher's exact test as appropriate. A p value of less than 0.05 was considered significant.

RESULTS

A total of 14,109 patients were included (mean age 2.7 ± 4.0 years), of whom 13,408 (95.0%) received SAP and 701 (5.0%) did not. Cefazolin was the most common agent (94.7%). White (8,246, 58%) was the most common race, though significant baseline differences existed in race/ethnicity between the SAP and no-SAP groups (p < 0.001). Unadjusted 30-day SSI rates were 4.7% for the SAP group and 4.4% for the no-SAP group (p = 0.8). In the weighted analysis, SAP was not associated with a reduction in SSIs (AOR 1.01, 95% CI 0.69-1.46), unplanned readmissions (AOR 0.93, 95% CI 0.70-1.22), or reoperations (AOR 0.78; 95% CI 0.48-1.27). Sub-analysis stratified by risk profile further confirmed no statistically significant benefit from prophylaxis in reducing infectious complications.

CONCLUSIONS

Routine surgical antibiotic prophylaxis appears not to be associated with improved short-term outcomes or reduced infection rates following pediatric gastrostomy tube placement. These findings support reevaluation of institutional protocols to potentially reduce unnecessary antibiotic exposure without compromising patient safety.