TOPLINE:

The use of postoperative antimicrobial prophylaxis was not associated with improved clinical outcomes in pediatric patients undergoing minimally invasive pectus excavatum repair — an operative correction for congenital chest wall deformity.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess if postoperative antimicrobial prophylaxis is associated with surgical site infections and other resource intensive outcomes after pectus excavatum repair in children.
• Overall, 3552 children (median age at operation, 15.4 years; 87.3% boys) who underwent minimally invasive repair from 2021 to 2023 were included; those who received postoperative antibiotic prophylaxis were propensity matched with those who did not.
• The primary exposure was the continuation of prophylactic antibiotic use after the surgical incision was closed; median duration of postoperative antibiotic prophylaxis was 21.6 hours.
• Primary outcomes were 30-day rates of postoperative surgical site infections, reoperation, and hospital readmission; a hospital-level analysis compared outcomes between hospitals with high vs low rates of postoperative antibiotic use.

TAKEAWAY:

• The rates of postoperative surgical site infections were similar between those who did and did not receive postoperative antimicrobial prophylaxis (adjusted odds ratio [aOR], 0.90; 95% CI, 0.50-1.61).
• The rates of reoperation and hospital readmission also did not differ significantly between those who received postoperative antimicrobial prophylaxis and those who did not.
• No correlation was found between hospital-level postoperative antibiotic use — either the rates of use or the median duration — and the observed-to-expected rate ratio for any evaluated outcome.

IN PRACTICE:

“Given that this procedure accounts for the highest relative burden of potentially avoidable postoperative antibiotic days in pediatric general surgery, reducing postoperative prophylaxis in this cohort could make a substantial impact in advancing antimicrobial stewardship,” the authors wrote.

SOURCE:

This study was led by Kerri A. McKie, MD, MPH, Boston Children’s Hospital, Harvard Medical School, Boston. It was published online on September 4, 2025, in JAMA Network Open.

LIMITATIONS:

This study was limited by its retrospective design, which potentially led to misclassification, and potential unmeasured confounding. Postoperative prophylaxis data were unavailable for patients with coexisting oncologic or hematologic conditions, limiting the generalizability of the findings to this subgroup. Finally, because the analysis was restricted to hospitals participating in the National Surgical Quality Improvement Program-Pediatric, the results may not apply to institutions outside this network.

DISCLOSURES:

This study was supported by the Children’s Hospital Surgery Foundation. Some authors disclosed being employees of or receiving travel support, grants, and/or personal fees from the American College of Surgeons and/or the Agency for Healthcare Research and Quality outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.