Abstract
Background: There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae following palatoplasty. Prescribing should be evidence based as antibiotic stewardship is integral to reducing antibiotic resistance. We set out to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae.
Methods: A prospective national multi-centre cohort study of cases submitted to the Cleft Collective Study from specialist cleft services was undertaken. The sample comprised participants who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centres between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula.
Results: Fistula data was available for 167 participants when exploring antibiotic regimen and 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2=4.57, P=0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav or an alternative antibiotic (χ2=0.16, P=0.69). Postoperative fistulae increased with the extent of the cleft (χ2=20.39, P<0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics OR 1.36, 95% CIs 0.53-3.51; antibiotics up to 7 days postoperatively OR 0.68, 95% CIs 0.26-1.80).
Conclusions: The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trial.
Methods: A prospective national multi-centre cohort study of cases submitted to the Cleft Collective Study from specialist cleft services was undertaken. The sample comprised participants who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centres between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula.
Results: Fistula data was available for 167 participants when exploring antibiotic regimen and 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2=4.57, P=0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav or an alternative antibiotic (χ2=0.16, P=0.69). Postoperative fistulae increased with the extent of the cleft (χ2=20.39, P<0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics OR 1.36, 95% CIs 0.53-3.51; antibiotics up to 7 days postoperatively OR 0.68, 95% CIs 0.26-1.80).
Conclusions: The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trial.
| Original language | English |
|---|---|
| Pages (from-to) | E5589 |
| Journal | Plastics and Reconstructive Surgery Global Open |
| Volume | 12 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 6 Feb 2024 |
Bibliographical note
Funding Information:The Cleft Collective Cohort Studies is funded by The Scar Free Foundation, The Underwood Trust, and the Vocational Training Charitable Trust Foundation. This secondary data analysis was funded by Craniofacial Australia. This publication involves data derived from independent research funded by The Scar Free Foundation (REC approval 13/SW/0064). Data were provided under application number CC035-AD. We are grateful to the families who participated in the study, the UK NHS cleft teams, and The Cleft Collective team, who helped facilitate the study. The views expressed in this publication are those of the authors and not necessarily those of The Scar Free Foundation or The Cleft Collective Cohort Studies team. Recruitment is ongoing across the United Kingdom via the 16 cleft surgical sites, and data collected are available as a resource for researchers and clinicians to answer their own cleft related questions ( http://www.bristol.ac.uk/cleft-collective/professionals/access ).
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