Surgical Antibiotic Prophylaxis Use in Pediatric and Adolescent Ovarian Surgery: A NSQIP-Pediatric Analysis.

INTRODUCTION: The American College of Obstetricians and Gynecologists recommends avoidance of surgical antibiotic prophylaxis (SAP) for laparoscopic ovarian procedures. However, these recommendations exclude patients <18 years old. This study aims to understand SAP use in pediatric ovarian surgery and its association with surgical site infection (SSI). METHODS: Perioperative SAP details and SSI rates from the National Surgical Quality Improvement Program - Pediatrics database were obtained for patients <18 years undergoing clean ovarian surgery, including salpingo-oophorectomy (USO), ovarian sparing surgery (OSS), and oophorectomy, from 2021-2023 and supplemented with a detailed review of relevant patients at our institution. SSI rates were compared in those who did and did not receive SAP. RESULTS: Among 2,137 ovarian surgeries, 50.5% received SAP. Patients undergoing open procedures were more likely to receive SAP than laparoscopic (69.1% vs 45.9%, p<0.001). Pediatric and adult general surgeons (64.8% and 64.9%) administered SAP more than gynecologists (24.2%, p<0.001). Overall SSI risk was 1.1% (n=24): 0.5% (n=5) with SAP and 1.8% with no-SAP (n=19, p=0.003). SSI rate was 1.9% in oophorectomy and 1.0% in OSS. On multivariable analysis, SAP was associated with decreased SSI (OR 0.24, 95% CI:0.08-0.62, p=0.006). SSI was associated with BMI >85th percentile (OR 3.20, 95% CI:1.41-10.3, p=0.038). CONCLUSION: SAP administration in pediatric ovarian procedures is common and variable between specialties. Overall SSI risk is low, suggesting that while SAP administration is statistically significant in this analysis, it is not clinically significant. For patients with BMI >85th percentile, SAP may be considered, but others are unlikely to significantly benefit.