Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: The use of perioperative antibiotics in sialendoscopy remains controversial and is largely dependent on surgeon preference. To date, there is limited clinical data to either support or discourage this practice.
Objective: To assess the impact of the perioperative use of antibiotics in sialendoscopy procedures on the submandibular gland for the indication of sialolithiasis on the post-operative infection rates.
Methods: A multi-institutional retrospective cohort study was conducted to identify patients who had undergone sialendoscopy for submandibular gland stones. Data was collected on patient demographics, comorbidities, disease factors, perioperative factors, and antibiotic use, class, and duration.
Results: A total of 333 patients from 4 institutions were included in the study. The overall rate of infection was 5.7%, ranging from 4.3% to 10.0% depending on the institution. Perioperative antibiotics were used in 58.3% of cases, including intraoperatively in 47.4% and post-operatively in 31.8%. The rate of post-operative antibiotic usage varied significantly between institutions, ranging from 15.4% to 52.4%. There was no statistically significant difference in the rates of post-operative infection between those who received post-operative antibiotics (RR :1.25, 95%CI: 0.51-3.08), intra-operative antibiotics (RR :1.3, 95%CI: 0.51-2.95), any perioperative antibiotics (RR :1.23, 95%CI: 0.51-3.04), and no antibiotics (reference group). Among the variables analyzed, only perioperative antibiotic class was found to be associated with post-operative infection rates. Doxycycline use was associated with a statistically significant higher rate of infection (RR: 18.92, 95%CI: 10.91-32.81). However, this effect may be attributable to the small sample size of patients receiving doxycycline (N=1) and should be interpreted with caution. No other antibiotic classes were found to have a significant association with infection.
Conclusions: This multi-institutional retrospective cohort study aimed to evaluate the impact of perioperative antibiotic use in sialendoscopy procedures of the submandibular gland performed for sialolithiasis. We found no association between use of post-operative, intra-operative, or any perioperative antibiotics on post-operative infection rates. While there are inherent limitations with a retrospective cohort study, this research adds to the existing literature suggesting antibiotics need not be routinely administered perioperatively for sialendoscopy.