Antibiotic prophylaxis for the prevention of fistulae in cleft palate repair: A quality improvement study

Background Postoperative infection following cleft palate repair can lead to wound dehiscence and subsequent fistula formation. To prevent post this, many surgeons advocate the use of post-operative antibiotic prophylaxis. The use of antibiotics in children is not without risks and with limited published data and variability both countrywide and in our unit, we wanted to address this research question. Objective To assess fistula rates and whether the provision of antibiotics postoperatively affected the incidence of oronasal fistula formation in patients with cleft palate. Methodology We performed an institutional retrospective study using data from patients undergoing primary palatoplasty between August 2021 and August 2022. These patients were divided into two groups. Group A included patients who received antibiotics only on induction and Group B additionally received post-operative antibiotic prophylaxis for 7 days. All participants (97) were evaluated for incidence of post-operative fistula formation. Results There was no evidence to suggest a difference in the fistula rate between the different timings of antibiotic regimen in Cycle 1; on induction + two intravenous doses (Group A) P=0.807 and 7 days postoperatively (Group B) P=0.820. Also, in cycle 2 there was no difference in fistula rates between the two groups; P = 0.546 for Group A and P= 0.571 for Group B. Conclusion Our study suggests that use of antibiotics postoperatively does not influence the formation of postoperative fistulae in cleft palate. This calls for a national randomised controlled study to answer this research question and achieve standardisation of practice.