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J Neurol Surg B Skull Base 2023; 84(02): 157-163
DOI: 10.1055/a-1771-0372
Original Article

Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery

Yosef Dastagirzada   *
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Carolina Benjamin   *
2   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
Julia Bevilacqua
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Jason Gurewitz
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Chandra Sen
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
John G. Golfinos 
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Dimitris Placantonakis
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Jafar J. Jafar
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
,
Seth Lieberman
3   Department of Otolaryngology, NYU Langone Health, New York, New York, United States
,
Rich Lebowitz
3   Department of Otolaryngology, NYU Langone Health, New York, New York, United States
,
Ariane Lewis
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
4   Department of Neurology, NYU Langone Health, New York, New York, United States
,
Donato Pacione
1   Department of Neurosurgery, NYU Langone Health, New York, New York, United States
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Abstract

Background Postoperative prophylactic antibiotic usage for endoscopic skull base surgery varies based on the institution as evidence-based guidelines are lacking. The purpose of this study is to determine whether discontinuing postoperative prophylactic antibiotics in endoscopic endonasal cases led to a difference in central nervous system (CNS) infections, multi-drug resistant organism (MDRO) infections, or other postoperative infections.

Methods This quality improvement study compared outcomes between a retrospective cohort (from September 2013 to March 2019) and a prospective cohort (April 2019 to June 2019) after adopting a protocol to discontinue prophylactic postoperative antibiotics in patients who underwent endoscopic endonasal approaches (EEAs). Our primary end points of the study included the presence of postoperative CNS infection, Clostridium difficile (C. diff), and MDRO infections.

Results A total of 388 patients were analyzed, 313 in the pre-protocol group and 75 in the post-protocol group. There were similar rates of intraoperative cerebrospinal fluid leak (56.9 vs. 61.3%, p = 0.946). There was a statistically significant decrease in the proportion of patients receiving IV antibiotics during their postoperative course (p = 0.001) and those discharged on antibiotics (p = 0.001). There was no significant increase in the rate of CNS infections in the post-protocol group despite the discontinuation of postoperative antibiotics (3.5 vs. 2.7%, p = 0.714). There was no statistically significant difference in postoperative C. diff (0 vs. 0%, p = 0.488) or development of MDRO infections (0.3 vs 0%, p = 0.624).

Conclusion Discontinuation of postoperative antibiotics after EEA at our institution did not change the frequency of CNS infections. It appears that discontinuation of antibiotics after EEA is safe.

Keywords

endoscopic endonasal surgery - endoscopic endonasal approach - transsphenoidal - antibiotics - prophylaxis - pituitary

Previous Presentations

Portions of this work was presented at the NASBS Meeting in San Antonio, Texas in February 2020.


* Co-First Authors.




Publication History

Received: 16 July 2021

Accepted: 24 January 2022

Accepted Manuscript online:
14 February 2022

Article published online:
04 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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