TRIO037 - The Economic Viability of Routine Preoperative Penicillin Allergy Testing in Preventing Inappropriate Clindamycin Use in Otolaryngological Surgery
Friday, April 29, 2022
3:55 PM – 4:00 PM CT
Location: Landmark B
Megana Challa BS; Edward D. McCoul MD MPH; Philip G. Chen MD
Educational Objective: Patients mislabeled with a penicillin allergy are often inappropriately given prophylactic clindamycin instead of the usual first generation cephalosporin or aminopenicillin in otolaryngological surgery. As such, otolaryngologists may be unnecessarily causing harm to this patient population, given clindamycin's associated risk of clostridium difficile infections (CDI) and poorer wound healing. Penicillin allergy testing exists to rectify this problem; however, its economic viability as a routine preoperative intervention has not been investigated in patients undergoing otolaryngological surgery. At the conclusion of this presentation, participants should be able to 1) determine when routine preoperative penicillin allergy testing is an economically self-sustainable solution in preventing the inappropriate use of clindamycin; and 2) assess the ability of such testing to achieve this level of economic sustainability.
Objectives: To determine the economic feasibility of routine preoperative penicillin allergy testing in preventing the inappropriate use of prophylactic clindamycin among patients mislabeled with a penicillin allergy prior to otolaryngological surgery.
Study Design: Break even analysis.
Methods: The average cost of penicillin allergy testing and average cost of a clostridium difficile infection (CDI) were obtained from existing literature. A break even equation using these variables was derived to calculate the absolute risk reduction (ARR) in baseline CDI rate due to clindamycin exposure required for preoperative penicillin allergy testing to be economically self-sustainable. The hypergeometric distribution equation was used to calculate the probability that current penicillin skin testing can achieve this ARR. Results: Preoperative penicillin allergy testing was found to be economically self-sustainable if it could decrease the baseline CDI rate by an ARR of 0.85 percent. The probability of current penicillin skin testing to achieve this ARR depended on the baseline CDI rate and the number of patients to be tested. At a baseline CDI rate >/= 2 percent, the probability of penicillin skin testing to achieve economic sustainability was found to be 100 percent regardless of how much patients were tested.
Conclusions:In patients mislabeled with a penicillin allergy, routine preoperative penicillin allergy testing may be an economically self-sustainable option to prevent the inappropriate use of clindamycin during otolaryngological surgery. Otolaryngologists should consider performing more penicillin skin tests in patients with an unconfirmed penicillin allergy.