O2088: Questioning Prophylactic Antibiotic Use for Pyloromyotomy: A Multi-institutional Study Using the Pediatric Health Information System Database

Background: Pyloromyotomy has a low rate of wound complications, including surgical site infection (SSI). A retrospective study from our institution demonstrated no significant decrease in wound complication or SSI rates for patients who received prophylactic antibiotics before laparoscopic pyloromyotomy. In order to confirm this finding in a larger population, we examined the Pediatric Health Information System (PHIS) database which includes 47 children’s hospitals in the United States. Our goal was to determine whether prophylactic antibiotics decreased wound complication and SSI rates.

Methods: Records for all infants diagnosed with pyloric stenosis between Jan 1, 2016 and Dec 31, 2021 were extracted from the PHIS database and analyzed for patient demographics, comorbid conditions, antibiotic treatments, and any complication within 30 days of the pyloromyotomy. Patients that received prophylactic antibiotics were compared to those who did not for complications, including SSI, evisceration or dehiscence, or reoperation within 30 days. Baseline characteristics were controlled for in the analysis. Propensity score matching and logistic regression were used to estimate the average effect of antibiotic treatment on complications. A generalized linear model was used to estimate the treatment effect and its standard error. The probability of complication and 95% confidence intervals (CI) are reported for both treated and untreated patients.

Results: A total of 15097 patients were diagnosed with pyloric stenosis among 47 hospitals, of whom 14247 (94.4%) underwent pyloromyotomy. Of those who underwent surgery, 29.5% were given antibiotics before surgery and 70.5% had no antibiotic prophylaxis. Patients who received antibiotics were more likely to have been admitted to the NICU (P=0.05) and had comorbidities including chronic and complex conditions, prematurity, and congenital defects (P < 0.01) (Table 1). A wide variation was found among hospitals in antibiotic utilization for these patients, ranging from 2.3-58.5%. The complication rate among those who received antibiotics was 1.64% (1.30-2.07%, 95% CI) versus 1.62% (1.28%-2.05%) for those who did not receive antibiotics. The odds for developing complications among those who received prophylaxis compared to those who did not is 1.10, (0.73, 1.41, 95%, p=0.93) suggesting there is no effect of antibiotic treatment on the rate of complication.

Conclusion: Among 47 children’s hospitals in the United States, there was a wide variation between hospitals regarding the usage of prophylactic antibiotics for pyloromyotomy. There was no difference in complication rates between patients who received prophylactic antibiotics and those who did not. The variation among hospitals in antibiotic prophylaxis indicates there is no strong consensus for their use and the lack of treatment effect would suggest they are unnecessary for pyloromyotomy.