TY - JOUR
T1 - Effectiveness of Prophylactic Preoperative Antibiotics in Mandible Fracture Repair
T2 - A National Database Study
AU - Wick, Elizabeth H.
AU - Deutsch, Brian
AU - Kallogjeri, Dorina
AU - Chi, John J.
AU - Branham, Gregory H.
N1 - Funding Information:
Funding source: National Center for Advancing Translational Sciences (UL1 TR002345; Elizabeth H. Wick), Agency for Healthcare Research and Quality (R24 HS19455; John J. Chi), Foundation for Barnes-Jewish Hospital (4090; Dorina Kallogjeri). The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences (grant UL1 TR002345) from the National Center for Advancing Translational Sciences of the National Institutes of Health and by the Agency for Healthcare Research and Quality (grant R24 HS19455). Research reported in this publication was also supported by The Foundation for Barnes-Jewish Hospital, Otolaryngology Surgical Outcomes and Quality Improvement Unit at Barnes-Jewish Hospital (grant 4090).
Funding Information:
We acknowledge Kate Peacock within the Center for Administrative Data Research team for her dedication and work in data acquisition and organization.
Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2021.
PY - 2021/12
Y1 - 2021/12
N2 - Objective: This is the first database study to assess the effectiveness of prophylactic preoperative antibiotics (PPAs) in mandible fracture repair. Study Design: Retrospective cohort. Setting: Database study using US inpatient and outpatient insurance claims submitted from July 2006 to March 2015. Methods: The IBM MarketScan Commercial Database was queried for adults aged 18 to 64 years who had undergone first-time mandible fracture repair according to Current Procedural Terminology codes for open and closed repair. Primary outcomes included surgical revision, local infection, and osteomyelitis. Rates were compared between cohorts based on whether or not patients had filled antibiotic prescriptions during the preoperative period alone. The effects of drug abuse and type of mandible repair (open vs closed) were explored. Multivariate Poisson regression models were used to calculate adjusted relative risk estimates, and 95% CIs were used to determine statistically significant differences. Results: A total of 2676 patients were included, with 847 (31.7%) filling PPAs and 1829 (68.3%) filling no antibiotics. Rates were 38.9% for revision, 5.8% for local infection, and 2.1% for osteomyelitis. After multivariate analysis, exposure to PPAs was not associated with surgical revision (adjusted relative risk, 1.04; 95% CI, 0.94-1.15), local infection (1.16; 0.82-1.64), or osteomyelitis (1.21; 0.68-2.14). Patients were more likely to fill PPAs if they underwent open repair (35.3%) versus closed (26.6%) (proportion difference, 8.7%; 95% CI, 5.2%-12.2%), but exposure to antibiotics did not predict outcomes on subgroup analysis. Conclusion: PPAs do not improve mandible repair outcomes, regardless of repair type.
AB - Objective: This is the first database study to assess the effectiveness of prophylactic preoperative antibiotics (PPAs) in mandible fracture repair. Study Design: Retrospective cohort. Setting: Database study using US inpatient and outpatient insurance claims submitted from July 2006 to March 2015. Methods: The IBM MarketScan Commercial Database was queried for adults aged 18 to 64 years who had undergone first-time mandible fracture repair according to Current Procedural Terminology codes for open and closed repair. Primary outcomes included surgical revision, local infection, and osteomyelitis. Rates were compared between cohorts based on whether or not patients had filled antibiotic prescriptions during the preoperative period alone. The effects of drug abuse and type of mandible repair (open vs closed) were explored. Multivariate Poisson regression models were used to calculate adjusted relative risk estimates, and 95% CIs were used to determine statistically significant differences. Results: A total of 2676 patients were included, with 847 (31.7%) filling PPAs and 1829 (68.3%) filling no antibiotics. Rates were 38.9% for revision, 5.8% for local infection, and 2.1% for osteomyelitis. After multivariate analysis, exposure to PPAs was not associated with surgical revision (adjusted relative risk, 1.04; 95% CI, 0.94-1.15), local infection (1.16; 0.82-1.64), or osteomyelitis (1.21; 0.68-2.14). Patients were more likely to fill PPAs if they underwent open repair (35.3%) versus closed (26.6%) (proportion difference, 8.7%; 95% CI, 5.2%-12.2%), but exposure to antibiotics did not predict outcomes on subgroup analysis. Conclusion: PPAs do not improve mandible repair outcomes, regardless of repair type.
KW - local infection
KW - mandible fracture
KW - osteomyelitis
KW - prophylactic antibiotics
KW - surgical revision
UR - http://www.scopus.com/inward/record.url?scp=85104333751&partnerID=8YFLogxK
U2 - 10.1177/01945998211004270
DO - 10.1177/01945998211004270
M3 - Article
C2 - 33845666
AN - SCOPUS:85104333751
SN - 0194-5998
VL - 165
SP - 798
EP - 808
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
IS - 6
ER -