Mp11-20 significant antibiotic use variations in pediatric testicular torsion surgery among us free-standing children's hospitals

You have accessJournal of UrologyCME1 May 2022MP11-20 SIGNIFICANT ANTIBIOTIC USE VARIATIONS IN PEDIATRIC TESTICULAR TORSION SURGERY AMONG US FREE-STANDING CHILDREN'S HOSPITALS John Panagides, Dylan Cahill, Rachel Saunders, and Hsin-Hsiao Wang John PanagidesJohn Panagides More articles by this author , Dylan CahillDylan Cahill More articles by this author , Rachel SaundersRachel Saunders More articles by this author , and Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no robust evidence for the efficacy of intraoperative antibiotics in preventing infections in testicular torsion surgery. In the absence of clear guidelines regarding appropriate use of antibiotic prophylaxis, the factors influencing these differences in practice pattern 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. METHODS: We utilized the Pediatric Health Information System (PHIS) database to identify patients ≤18 years-old who underwent testicular septopexy or orchiectomy with 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 5,305 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 = 1.62 (95% CI 1.41-1.87, p <0.001) and hospital (p <0.001) remained significantly associated with choice of antibiotic prophylaxis for testicular torsion surgeries. Figure 1 demonstrates the predicted probability of receiving antibiotic prophylaxis for an index patient by PHIS hospitals. CONCLUSIONS: There is wide variation in antibiotic prophylaxis use for patients undergoing testicular detorsion at freestanding children’s hospitals in the United States. Older patients are more likely to receive antibiotic prophylaxis prior to the testicular torsion surgery. Given the risks associated with excessive antibiotic use, an understanding of the factors and proper standardization is warranted. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e164 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Panagides More articles by this author Dylan Cahill More articles by this author Rachel Saunders More articles by this author Hsin-Hsiao Wang More articles by this author Expand All Advertisement PDF downloadLoading ...