Preoperative antibiotics prevent complications in hypospadias repair

Antibiotic prophylaxis prior to hypospadias repair results in reduced complications in longer procedures, reports a study.

A team of investigators categorized hypospadias repairs using the 2021 to 2022 National Surgical Quality Improvement Program Pediatric Registry into (1) 1-stage distal hypospadias repairs, (2) 1-stage proximal hypospadias repairs and second-/third-stage urethroplasties, and (3) repair of hypospadias complications. Patients with missing data on preoperative antibiotic prophylaxis use were excluded.

The risk of wound complications (wound infection or dehiscence) and UTI was examined. Binomial logistic regressions were conducted with selected covariates such as age, race, prematurity, relative value unit, operative time, antibiotic prophylaxis, and American Society of Anesthesiologists score.

Of the participants, 5,026 were categorized into group 1, 1,428 into group 2, and 1,159 into group 3. Preoperative antibiotics were administered to 6,392 patients (84.0 percent). The rates of UTI and wound complication were about 3 percent.

Notably, multivariable analysis revealed the association of preoperative antibiotics with decreased wound complications in longer procedures (p=0.018).

However, “[due] to the overall very low incidence of postoperative complications, clinicians should consider omitting preoperative antibiotics in hypospadias repairs, particularly in lower-risk patients,” the investigators said. 

“Complication rates after hypospadias repairs are variable in the literature, ranging from under 10 percent for distal hypospadias repairs to up to 70 percent for proximal repairs in various studies,” they noted.