{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T10:33:12Z","timestamp":1784197992239,"version":"3.55.0"},"reference-count":14,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250858-4\"><jats:title>Importance<\/jats:title><jats:p>Postoperative antimicrobial prophylaxis (PAP) is frequently used following pectus excavatum repair and accounts for the highest relative burden of potentially avoidable postoperative antibiotic days among pediatric general surgical procedures.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250858-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the association of postoperative antibiotic prophylaxis with postoperative rates of surgical site infections, reoperation, and readmission in children undergoing pectus excavatum repair who did and did not receive postoperative antibiotic prophylaxis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250858-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study included children aged younger than 18 years undergoing pectus excavatum repair from January 2021 to December 2023 at 141 hospitals participating in the National Surgical Quality Improvement Program\u2013Pediatric.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250858-7\"><jats:title>Exposures<\/jats:title><jats:p>Continuation of prophylactic antibiotics after incision closure.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250858-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Primary outcomes included 30-day postoperative rates of surgical site infections (SSIs), reoperation, and readmission. Propensity score matching was used to balance groups (without PAP or with PAP) on patient and operative characteristics plausibly associated with PAP use and outcomes. Mixed-effects models were used to compare outcomes between matched groups, with a random effect used to account for hospital clustering. A complementary hospital-level analysis was used to explore the correlation between rates of PAP use and observed to expected (O\/E) rate ratios for each outcome after adjusting for differences in patient and procedural characteristics among hospitals.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250858-9\"><jats:title>Results<\/jats:title><jats:p>A total of 3552 patients were included (median [IQR] age, 15.4 [14.5-16.4] years; 3099 males [87.3%]). Postoperative prophylaxis was used in 1949 patients (54.9%) for a median (IQR) duration of 21.6 (14.6-24.0) hours. In the matched cohort of 3168 patients, outcomes were similar in children receiving PAP compared with those who did not, with 26 of 1584 (1.6%) of children who received PAP developing an SSI compared with 29 of 1584 (1.8%) of children who did not receive PAP (odds ratio [OR], 0.90; 95% CI, 0.50-1.61). For children requiring reoperation, 25 of 1584 (1.6%) received PAP compared with 27 of 1584 (1.7%) who did not (OR, 0.98; 95% CI, 0.52-1.83). For readmission, 41 of 1584 (2.6%) children received PAP compared with 57 of 1584 (3.6%) who did not (OR, 0.81; 95% CI, 0.48-1.34). In the hospital-level analysis, no correlation was found between rates of postoperative prophylaxis use and O\/E rate ratios for SSIs (Spearman \u03c1, \u22120.07; <jats:italic>P<\/jats:italic>\u2009=\u2009.43), reoperation (Spearman \u03c1, \u22120.01; <jats:italic>P<\/jats:italic>\u2009=\u2009.93), or readmission (Spearman \u03c1, \u22120.03; <jats:italic>P<\/jats:italic>\u2009=\u2009.65).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250858-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cohort study of 3552 pediatric patients undergoing pectus excavatum repair, postoperative antibiotic use was not associated with improved outcomes, challenging the routine use of postoperative prophylaxis in the operative management of this condition.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.30449","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T15:31:24Z","timestamp":1756999884000},"page":"e2530449","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative Antimicrobial Prophylaxis Use and Outcomes in Pectus Excavatum Repair"],"prefix":"10.1001","volume":"8","author":[{"given":"Kerri A.","family":"McKie","sequence":"first","affiliation":[{"name":"Department of Surgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoosha","family":"Moturu","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne A.","family":"Graham","sequence":"additional","affiliation":[{"name":"Program for Patient Safety and Quality, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melvin","family":"Coleman","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiping","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Grant","sequence":"additional","affiliation":[{"name":"Children\u2019s Surgery Program, Continuous Quality Improvement, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline M.","family":"Saito","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Children\u2019s National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce L.","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"},{"name":"University of California, Davis Health System, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Cina","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G.","family":"Newland","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Nationwide Children\u2019s Hospital, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Goretsky","sequence":"additional","affiliation":[{"name":"Department of Surgery, Children\u2019s Hospital of the King\u2019s Daughters, Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford Y.","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn J.","family":"Rangel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"issue":"3","key":"zoi250858r1","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/j.suc.2012.03.001","article-title":"Chest wall deformities in pediatric surgery.","volume":"92","author":"Obermeyer","year":"2012","journal-title":"Surg Clin North 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stewardship efforts.","volume":"278","author":"Anandalwar","year":"2023","journal-title":"Ann Surg"},{"issue":"1","key":"zoi250858r9","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jpedsurg.2019.09.057","article-title":"Trends in the use of surgical antibiotic prophylaxis in general pediatric surgery: are we missing the mark for both stewardship and infection prevention?","volume":"55","author":"Anandalwar","year":"2020","journal-title":"J Pediatr Surg"},{"issue":"6","key":"zoi250858r12","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1016\/j.jpedsurg.2018.02.090","article-title":"Multivariate analysis of risk factors for Nuss bar infections: a single center study.","volume":"53","author":"Obermeyer","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"7","key":"zoi250858r13","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1001\/jamasurg.2019.0569","article-title":"Association of duration and type of surgical prophylaxis with antimicrobial associated adverse events.","volume":"154","author":"Branch-Elliman","year":"2019","journal-title":"JAMA Surg"},{"key":"zoi250858r7","unstructured":"American College of Surgeons National Surgical Quality Improvement Program\u2013Pediatrics. Surgical Antimicrobial Prophylaxis Semiannual Report (NSQIP-P SAP SAR): dates of surgery Jan 1, 2023-Dec 31, 2023. American College of Surgeons. July 2024. Accessed August 8, 2025. https:\/\/www.facs.org\/quality-programs\/data-and-registries\/acs-nsqip\/"},{"key":"zoi250858r10","unstructured":"American College of Surgeons (ACS). User Guide for the 2023 ACS NSQIP Pediatric Participant Use Data File (PUF). 2024. Accessed August 8, 2025. https:\/\/www.facs.org\/media\/55ckykpn\/peds_nsqip_userguide_2023.pdf"},{"key":"zoi250858r11","unstructured":"American College of Surgeons (ACS). User guide for the 2022 ACS NSQIP Pediatric Surgical Antibiotic Prophylaxis Participant Use Data File (SAP PUF). 2024. Accessed December 2, 2024. https:\/\/www.facs.org\/media\/5kphhbo4\/peds_nsqip_sap_sar_userguide_2023.pdf"},{"key":"zoi250858r14","unstructured":"Centers for Disease Control and Prevention. Antibiotic resistance threats in the US 2019. 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