Surgical antibiotic prophylaxis utilization for pediatric thyroid operations: A NSQIP-Pediatric analysis.

INTRODUCTION

Thyroid operations are generally clean procedures. However, there are no pediatric-specific guidelines regarding surgical antibiotic prophylaxis (SAP) for thyroid operations. This study aims to understand SAP utilization for thyroid operations in children and its association with surgical site infection (SSI).

METHODS

Patients <18 years old who underwent clean thyroid lobectomy and total thyroidectomy between 2021 and 2023 were identified in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Patients with pre-existing infection and non-clean wound class were excluded. A single institutional cohort was also analyzed. SSI rates were compared between those who did and did not receive SAP.

RESULTS

Among the 1040 thyroid procedures, 45.1% received SAP. SAP was administered more commonly by pediatric (69.0%) and adult otolaryngologists (48.7%) compared to pediatric (30.3%) and general surgeons (14.2%, p < 0.001). The SSI rate in the entire cohort was 0.6% (n = 6). All SSIs occurred in the no-SAP group (1.1%, p = 0.035 when compared to SAP group). All patients with SSI underwent total thyroidectomy. Of the six patients with SSI, 83.3% (n = 5) had thyrotoxicosis, 83.3% (n = 5) had BMI >85th percentile, and 66.7% (n = 4) were ASA III. The number needed to treat for SAP administration was 95.2 to prevent one SSI. The SSI rate in the single institution analysis with minimal SAP administration was 1.3%.

CONCLUSIONS

SSI risk following pediatric thyroid operations is extremely low. Patients undergoing total thyroidectomy for thyrotoxicosis and those with BMI >85th percentile may be subgroups for whom SAP should be considered. Others warrant appropriate antibiotic stewardship and are unlikely to benefit.