Cost analysis of antibiotic prophylaxis in clean head and neck surgery.
OBJECTIVE
This study was undertaken to assess the excess cost of hospitalization accrued to patients who develop postoperative wound infection following neck dissection in which the wound was not exposed to secretions from the upper aerodigestive tract.


METHODS
A retrospective cohort of patients who underwent "clean" neck dissection from 1976 to 1989 were evaluated. Antibiotic administration (yes or no), post-operative wound infection (yes or no), and duration and cost of hospitalization were assessed.


METHODS
All surgeries were performed in a university medical center.


METHODS
All patients underwent neck dissection in which the procedure was clean, ie, there was no exposure to secretions from the upper aerodigestive tract.


METHODS
Patients were assessed to determine administration of antibiotics (yes or no), development of postoperative wound infection (yes or no), and duration and cost of hospitalization.


RESULTS
Wound infection developed in 10 (10%) of 99 patients who did not receive antibiotics. Of 93 patients who received perioperative antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant. The type II (beta) error was greater than 0.2, suggesting that a significant difference may have been missed (false-negative) as a result of the small number of patients studied. The excess cost accrued to each patient who developed a postoperative wound infection was in excess of $36,000 (1992 dollars). The cost of administration of antibiotic prophylaxis to 100 patients is less than this amount.


CONCLUSIONS
The decision to withhold antibiotic prophylaxis should not be made in an effort to reduce hospital costs.
Blair
E A
EA
Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pa.
Johnson
J T
JT
Wagner
R L
RL
Carrau
R L
RL
Bizakis
J G
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D002481:Cellulitis / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D002511:Cephalosporins / Q000191:economics / Q000627:therapeutic use; D002981:Clindamycin / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D017577:Cutaneous Fistula / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D004210:Dissection; D016527:Drug Costs; D005260:Female; D006257:Head / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D011292:Premedication / Q000191:economics*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics / Q000209:etiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002981:Clindamycin