Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From NSQIP-Pediatrics

Literature supporting antimicrobial prophylaxis for hypospadias repairs is lacking, with largest studies including several hundred subjects. We sought to evaluate the association of a single dose of preoperative antibiotics in hypospadias repairs on postoperative outcomes using National Surgical Quality Improvement Program Pediatrics (NSQIP-P). The 2021-2022 NSQIP-P database was used to categorize hypospadias repairs into 3 groups - (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 regarding preoperative antibiotic prophylaxis administration were excluded. We evaluated the risk of wound complications (wound infection or dehiscence) and urinary tract infections (UTI). Binomial logistic regressions were performed with selected covariates including age, race, prematurity, relative value unit, operative time, American Society of Anesthesiologists score, and antibiotic prophylaxis. There were 5026 patients in group 1, 1428 patients in group 2, and 1159 patients in group 3. 6392 (84.0%) patients received preoperative antibiotics. Overall, UTI and wound complications rate was about 3%. On multivariable analysis, preoperative antibiotics were associated with decreased wound complications in longer procedures (p=0.018). Preoperative antibiotics correlated with decreased wound complications in longer procedures. Due to the overall very low incidence of postoperative complications, clinicians should consider omitting preoperative antibiotics in hypospadias repairs, particularly in lower risk patients.