O2155: Association of antimicrobial prophylaxis with surgical site infection risk in children undergoing laparoscopic orchiopexy

Background: Controversy and a paucity of rigorous comparative effectiveness data exists surrounding the benefit of antimicrobial prophylaxis for laparoscopic orchidopexy. The purpose of this study was to compare rates of surgical site infection (SSI) in children undergoing laparoscopic orchidopexy who did and did not receive antimicrobial prophylaxis.

Methods: Children < 18 years undergoing laparoscopic orchidopexy were identified from the 2021 and 2022 ACS NSQIP-Pediatric General Participant Use Files (PUF). Outcomes including 30-day postoperative SSI (incisional and organ space) were obtained from the General Participant Use PUF and merged with prophylaxis utilization data from the NSQIP-Pediatric Surgical Antibiotic Prophylaxis PUF for the same period. Outcomes were compared between patients after propensity matching on patient characteristics (age, race/ethnicity, ASA class, and BMI) and procedural characteristics (operative duration, sidedness [unilateral vs. bilateral], and admission status [inpatient vs. ambulatory]).

Results: 1954 cases were identified from 157 hospitals. The median age at operation was 1.5 years (IQR: 1.0–2.8), 15.1% of procedures were bilateral, and 9.7% were performed in the inpatient setting. The overall SSI rate was 1.3% and all SSI events were incisional (no organ space infections were reported). Overall, 54.8% received antimicrobial prophylaxis and cefazolin was used in 97.6% of these cases. Prophylaxis utilization was associated with inpatient status, higher BMI, Hispanic race/ethnicity, bilateral repair, and longer operative duration (table). Following matching, no differences remained between groups in any patient or procedural characteristics (table). No differences in SSI rates were found between groups in either the unmatched (prophylaxis: 1.1% [12/1070] vs. no prophylaxis: 1.6% [14/884]; p=0.37) or matched analysis (prophylaxis: 1.4% [8/578] vs. no prophylaxis: 1.7% [10/578]; OR p=0.79, 95%CI 0.31-2.03).

Conclusion: Use of antimicrobial prophylaxis was not associated with a reduction in SSI rates in children undergoing laparoscopic orchiopexy. These data argue against the routine use of antimicrobial prophylaxis in children undergoing these procedures.