Significant antibiotic use variations in testicular torsion surgery among us free-standing children's hospitals.

Abstract

Purpose: There is no robust evidence for the efficacy of intraoperative antibiotics in preventing infections in testicular torsion surgery, the incidence of which is reported to be <0.2 %. In the absence of clear guidelines regarding the appropriate use of antibiotic prophylaxis, the factors influencing these differences in practice patterns remain unclear. Our study aimed to identify both patient and institution-level factors affecting whether a pediatric patient undergoing emergency testicular detorsion (orchiopexy or orchiectomy) will receive antibiotic prophylaxis.

Materials and methods: We utilized the Pediatric Health Information System (PHIS) database to identify patients≤18 years old who underwent testicular septopexy or orchiectomy with the diagnosis of torsion of the testis between 2015 and 2021. Patient visits for repeated presentations of torsion were excluded from the analysis. We used multivariate logistic regression to evaluate if pre-procedural antibiotic prophylaxis was associated with hospital-level factors (treating hospital) or patient-level factors (case complexity, concurrent orchiectomy, age category, race/ethnicity, income quintile, insurance).

Results: We included 5313 children who underwent surgeries for testicular torsion. Median age was 13 (IQR 10-15 years). 74.0 % patients received antibiotic prophylaxis. Compared to no antibiotic prophylaxis, those who received antibiotic prophylaxis were significantly older (p < 0.001). After adjusting for race/ethnicity, orchiectomy vs septopexy, income quintiles, insurance, and comorbidities, older age (12-18 years compared to the 0-12 age group, OR = 1.6 (95 % CI 1.4-1.9, p < 0.001) and hospital (p < 0.001) remained significantly associated with choice of antibiotic prophylaxis for testicular torsion surgeries.

Discussion: There is wide variation in antibiotic prophylaxis use for patients undergoing testicular detorsion at freestanding children's hospitals in the United States. Older patients (age 12-18) are more likely to receive antibiotic prophylaxis prior to testicular torsion surgery. On the other hand, no obvious benefit in reducing subsequent hospital readmission rate was found associated with antibiotic prophylaxis. This study was limited by an inherent reliance on accurate documentation of antimicrobial-associated allergic reaction(s) and readmission rates in this PHIS database.

Conclusions: Given the risks associated with excessive antibiotic use, an understanding of the factors and proper standardization is warranted. Significant variation in antibiotic prophylaxis demonstrates the need for clearer guidelines and evidence-based practice. Future work may illustrate the potential impact on standardized protocols on reducing unwarranted antibiotic use.