Laryngectomy Complications Are Associated with Perioperative Antibiotic Choice

OBJECTIVE: To assess hospital- and physician-level variation in pattern of perioperative antibiotic use for laryngectomy and the relationship between pattern of antibiotic use and surgical site infection (SSI), wound dehiscence, and antibiotic-induced complications. STUDY DESIGN: Retrospective analysis of University HealthSystem Consortium data. SETTING: Academic medical centers and affiliated hospitals. SUBJECTS AND METHODS: Elective admissions for laryngectomy from 2008 to 2011 and associated 30-day readmissions were analyzed with multivariate logistic regression models. RESULTS: There were 439 unique antibiotic regimens (agents and duration) identified over the first 4 days of the 1865 admissions included in this study. Ampicillin/sulbactam, cefazolin + metronidazole, and clindamycin were the most common agents given on the day of surgery. Clindamycin was independently associated with higher odds of SSI (odds ratio [OR] = 3.87, 95% confidence interval [CI] = 2.31-6.49]), wound dehiscence (OR = 3.42, 95% CI = 2.07-5.64), and antibiotic-induced complications (OR = 3.01, 95% CI = 1.59-5.67) when given alone; it was also associated with higher odds of SSI (OR = 2.69, 95% CI = 1.43-5.05) and antibiotic-induced complications (OR = 2.20, 95% CI = 1.04-4.64) when given with other agents. These effects were stronger in a subsample of high-volume physicians and hospitals. CONCLUSION: There is substantial variability in perioperative antibiotic strategies for laryngectomy. Clindamycin was associated with much higher odds of short-term complications as compared to other common regimens. Based on these data, clinical trials should be planned to firmly establish the most effective and cost-effective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin-allergic patients.