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Administration Of Single-dose Antibiotics Does Not Decrease Oronasal Fistula Rates After Primary Palatoplasty.
Ishwarya S. Mamidi, BS, Esperanza Mantilla-Rivas, MD, Brynne A. Ichiuji, BA, Md Sohel Rana, MBBS, Karen I. Ramirez, MD, Jason Stein, BS, Marudeen Aivaz, BS, Monica Manrique, MD, Jennifer McGrath, MD, Gary F. Rogers, MD, Albert K. Oh, MD.
Children's National Hospital, Washington, DC, USA.

PURPOSE: Oronasal fistula (ONF) is a known complication after primary palatoplasty (PP). Studies investigating the effect of perioperative antibiotics on fistula rates after PP have been limited by inadequate sample size or reliance on self-reporting through national databases. In this study, the authors evaluated a large number of consecutive patients undergoing PP by two experienced full-time pediatric plastic surgeons at a single institution to evaluate if perioperative antibiotics decrease postoperative fistula rates.
METHODS: The authors examined their ongoing prospective database of patients who underwent PP between April 2009 and September 2019. Patients were classified into two groups. Group 1 had a single intraoperative dose of IV antibiotic, while Group 2 did not. Outcome measures included ONF formation, length of stay (LOS), and 30-day readmission rates. Multivariable Firth logistic regression was used to compare ONF formation, quantile regression to compare median LOS, and Chi-square test to compare readmission rate.
RESULTS: In the 424 consecutive patients (Group 1 n=215; Group 2 n=209) evaluated, ONF rates for Group 1 and 2 were 4.19% and 0.48% respectively. After adjusting for confounding variables, the rate of ONF between the two groups was not statistically significant (Adjusted Odds Ratio: 4.9; 95% CI: 0.8, 29.1; P= 0.08). Further analysis demonstrated no differences in median LOS (p=0.89) and readmission within 30 days (p= 0.12) between the two cohorts
CONCLUSION: Administration of a single-dose perioperative antibiotic did not affect fistula formation after PP. In addition, no significant effect was demonstrated on LOS and 30-day readmission rate.


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