Characterization of Perioperative Antibiotic Use in Esophageal and Airway Procedures

Corresponding Author Andrew Mudreac, MD, Division of General, Thoracic and Fetal Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA, (773) 706-1972, mudreaca@chop.edu Funding This work did not receive any funding. Conflict(s) of Interest None of the authors have any conflicts of interest to disclose. Background Perioperative antibiotic use for children undergoing surgical procedures for esophageal and airway disorder treatment (EAT) is highly variable. We developed institutional antimicrobial guidelines for EAT procedures to optimize antibiotic use and reduce variability, but we had not previously evaluated adherence to these guidelines. Methods We conducted a single-center retrospective cohort study to evaluate perioperative antibiotic use for all EAT procedures from 08/2022-11/2024. Procedures were categorized as primary or staged repair of esophageal atresia (EA) or complex EAT procedures (e.g., Aortopexy, Esophageal stricture excision, Esophagectomy, Esophagoplasty, Esophagostomy, Tracheopexy, or Tracheoplasty). The primary outcome was optimal antibiotic choice and duration based on alignment with antimicrobial stewardship recommendations (Table 1). Antibiotics for treatment of a diagnosed infection (e.g., UTI, pneumonia), or surgical complication, such as esophageal leak, or prophylaxis for another condition (e.g., UTI prophylaxis) were considered appropriate. Results Ninety-two cases were included in this study. Of those, 35 (38.0%) were primary EA repair, 24 (26.1%) were staged EA repair, and 33 (35.9%) were complex EAT procedure. Median postoperative antibiotic duration across all groups was 2 days [IQR 1, 6] (Fig. 1). Overall, antibiotic choice and duration was optimal in 45.7% of cases (45.7% in primary repair, 50.0% in staged repair, and 42.4% in complex EAT) (Fig. 2). Pre-operative regimens were more commonly optimal than post-operative: 94.3% vs. 48.6% in primary repair, 70.8% vs. 58.3% in staged repair and 90.9% vs. 42.4% in complex EAT cases. Appropriate intraoperative antibiotics were utilized in 51.1% of cases; piperacillin/tazobactam was selected in the other 48.9% of cases (Table 2). The most common reasons for suboptimal antibiotic selection and/or duration were concern for sepsis without a diagnosed infection and prolonged postoperative surgical prophylaxis. Postoperative infectious complications were rare: one patient developed an SSI and there were no confirmed cases of mediastinitis or postoperative abscess. Conclusion Despite development of an institutional consensus antimicrobial guideline for EAT procedures, there is significant variability in perioperative antibiotic use, particularly during the postoperative period. A targeted multidisciplinary effort to reduce inappropriate perioperative antibiotic usage in EAT patients may be beneficial.