title: Laryngectomy Complications Are Associated with Perioperative Antibiotic Choice.
abstract: OBJECTIVE
  To assess hospital- and physician-level variation in pattern of perioperative antibiotic use for laryngectomy and the relationship between pattern of antibiotic use and surgical site infection (SSI), wound dehiscence, and antibiotic-induced complications.
  
  
  METHODS
  Retrospective analysis of University HealthSystem Consortium data.
  
  
  METHODS
  Academic medical centers and affiliated hospitals.
  
  
  METHODS
  Elective admissions for laryngectomy from 2008 to 2011 and associated 30-day readmissions were analyzed with multivariate logistic regression models.
  
  
  RESULTS
  There were 439 unique antibiotic regimens (agents and duration) identified over the first 4 days of the 1865 admissions included in this study. Ampicillin/sulbactam, cefazolin + metronidazole, and clindamycin were the most common agents given on the day of surgery. Clindamycin was independently associated with higher odds of SSI (odds ratio [OR] = 3.87, 95% confidence interval [CI] = 2.31-6.49]), wound dehiscence (OR = 3.42, 95% CI = 2.07-5.64), and antibiotic-induced complications (OR = 3.01, 95% CI = 1.59-5.67) when given alone; it was also associated with higher odds of SSI (OR = 2.69, 95% CI = 1.43-5.05) and antibiotic-induced complications (OR = 2.20, 95% CI = 1.04-4.64) when given with other agents. These effects were stronger in a subsample of high-volume physicians and hospitals.
  
  
  CONCLUSIONS
  There is substantial variability in perioperative antibiotic strategies for laryngectomy. Clindamycin was associated with much higher odds of short-term complications as compared to other common regimens. Based on these data, clinical trials should be planned to firmly establish the most effective and cost-effective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin-allergic patients.
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA Operative Performance Research Institute, University of Chicago Medicine, Chicago, Illinois, USA Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois, USA alangerm@surgery.bsd.uchicago.edu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Langerman
authors.affiliation: Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Ham
authors.affiliation: Section of Infectious Diseases, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pisano
authors.affiliation: Operative Performance Research Institute, University of Chicago Medicine, Chicago, Illinois, USA Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pariser
authors.affiliation: University HealthSystem Consortium, Chicago, Illinois, USA.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.affiliation: Center for Health and the Social Sciences, University of Chicago Medicine, Chicago, Illinois, USA Hospital Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; clindamycin; laryngectomy; surgical site infection