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Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair.
Davies, Alex; Davies, Amy; Main, Barry; Wren, Yvonne; Deacon, Scott; Cobb, Alistair; McLean, Neil; David, David; Chummun, Shaheel.
Affiliation
  • Davies A; From the South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom.
  • Davies A; The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom.
  • Main B; The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom.
  • Wren Y; Bristol Dental School, University of Bristol, Bristol, United Kingdom.
  • Deacon S; Bristol Dental School, University of Bristol, Bristol, United Kingdom.
  • Cobb A; Oral and Maxillofacial Surgery, Bristol Dental Hospital, Bristol, United Kingdom.
  • McLean N; The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom.
  • David D; Bristol Dental School, University of Bristol, Bristol, United Kingdom.
  • Chummun S; From the South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom.
Plast Reconstr Surg Glob Open ; 12(2): e5589, 2024 Feb.
Article de En | MEDLINE | ID: mdl-38322814
ABSTRACT

Background:

There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae.

Methods:

The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula.

Results:

Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics OR 1.36; 95% confidence interval, 0.53-3.51; antibiotics up to 7 days postoperatively OR 0.68; 95% confidence interval, 0.26-1.80).

Conclusions:

The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials.

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Type d'étude: Risk_factors_studies Langue: En Journal: Plast Reconstr Surg Glob Open / Plastic and reconstructive surgery. Global open Année: 2024 Type de document: Article Pays d'affiliation: Royaume-Uni Pays de publication: États-Unis d'Amérique

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Type d'étude: Risk_factors_studies Langue: En Journal: Plast Reconstr Surg Glob Open / Plastic and reconstructive surgery. Global open Année: 2024 Type de document: Article Pays d'affiliation: Royaume-Uni Pays de publication: États-Unis d'Amérique