J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702669
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

Antibiotic Use in Lateral Skull Base Surgery: A Survey of the North American Skull Base Society

K. L. Li
1   Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
,
C. H. Fang
1   Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
,
V. S. Hawn
1   Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
,
V. Agarwal
2   Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York, United States
,
V. R. Kshettry
3   Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
,
E. Bellile
4   Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States
,
N. A. Akbar
1   Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
,
E. L. McKean
5   Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
,
W. M. Abuzeid
1   Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
,
H. S. Moskowitz
1   Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

 

Introduction: Antibiotic use in lateral skull base surgery (LSBS) has not been thoroughly investigated in the literature. As such, there is wide variability in antibiotic use and insufficient data to guide management. This study aims to describe the factors and patterns influencing antibiotic use in LSBS.

Methods: An online-based survey was designed and distributed to the membership of the North American Skull Base Society. Data were analyzed using multivariate analysis.

Results: The survey response rate was 25.6%, with a total of 208 respondents. 143 (68.8%) respondents performed LSBS, and 58.0% practice full-time in an academic institution. The majority of respondents (79.0%) are fellowship trained in skull base surgery. Most are neurosurgeons (68.5%) with the remaining being otolaryngologists (31.5%). 92.3% of respondents prescribe intraoperative antibiotics, and 89.4% cite reduction in the risk of postoperative infection risk as the motivating factor. Bivariate analysis showed that compared with academic surgeons, private practice surgeons are 13.3 times less likely to prescribe intraoperative antibiotics (OR 0.075 [95% CI: 0.012–0.455]; p = 0.011). Postoperative antibiotics were prescribed at a lower rate (61.5%) and were most commonly used to prevent postoperative infection (51.7%) or for the presence of purulence (14.0%). European surgeons were 4.7 and 1.5 times less likely to prescribe postoperative antibiotics than the Midwest United States and Central American surgeons, respectively (OR 0.214 [95% CI: 0.062–0.746]; p = 0.013; OR 1.5 [95% CI: 0.945–2.381]; p = 0.047). Asian surgeons are 4.3 times more likely to prescribe postoperative antibiotics than surgeons in the Western United States (OR 4.308 [95% CI: 0.987–18.796]; p = 0.044), and 10.9 times more likely than surgeons in Europe (OR 10.889 [95% CI: 2.262 – 52.416]; p = 0.001). The presence of active cerebral spinal fluid leak was associated with a 24.4 times increase in postoperative antibiotic use (OR 0.041 [95% CI: 0.008–0.207); p < 0.0001).

Conclusion: This study demonstrates significant variations in intraoperative and postoperative antibiotic use in LSBS. Future prospective randomized studies are needed to evaluate effective perioperative antibiotic use.