Kathryn A Schlosser, MD, Sean R Maloney, MD, James M Horton, MD, Tanushree Prasad, Paul D Colavita, Brant T Heniford, Vedra A Augenstein. Carolinas Medical Center
Aims: 8% of the US population reports a penicillin allergy (PA), with 1-2% demonstrating true allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis. This study evaluates the relationship of PA to outcomes after OVHR.
Methods: A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative characteristics, and outcomes were evaluated by reported PA.
Results: 1,103 patient allergy histories were reviewed. 22.0% of patients reported PA, 12.1% had documented rash/hives, 3.5% reported anaphylaxis, and 6.4% had no reaction documented. 24.5% of female patients reported PA (vs.18.6% males, p=0.02), as did 23.2% of Caucasian patients (vs.10.9% non-Caucasian, p=0.04), and 32.5% of patients with a history of MRSA (vs.21.2% non-MRSA patients, p=0.02). 17.0% of PA received a beta-lactam surgical prophylaxis (vs.85.4% non-PA patients) and were likely to have an existing mesh infection (12.8vs.7.8%,p=0.01), or contaminated case (32.1vs.25.0%,p=0.02). Postoperatively, PA patients had more wound complications, complications ≥ Clavien-Dindo grade 3 (CD≥3), and readmissions (32.4vs.40.5%,p=0.02; 32.9vs.43.2%,p=0.003; 20.7vs.28.8,p=0.008 respectively). Patients undergoing VHR without contamination or history of MRSA were examined. 19.9% of this cohort were PA, 16.5% of whom received a beta-lactam (vs.94.2% non-PA,p<0.0001). Cefazolin was most commonly used, (90.7% non-PA, 15.8% PA), followed by clindamycin (1.2% non-PA, 37.0% PA), and vancomycin (3.7% non-PA, 37.8% of PA). PA patients had higher rates of CD≥3 (35.8vs26.1,p=0.02), 30-day readmission (17.2vs.9.9%,p=0.01), and of surgical site occurrence requiring procedural intervention (31.8vs.23.3%,p=0.03). Multivariate analysis was performed to control for potentially confounding factors, and patients with PA were found to have higher rates of readmission (OR 1.80, CI 1.16-2.75) and CD≥3 (OR 1.58, CI 1.04-2.38).
Conclusion: PA is associated with a more complex VHR, resulting in adverse outcomes; however, controlling for contamination and MRSA history, PA patients not receiving a beta-lactam surgical prophylaxis have higher rates of adverse outcomes. PA testing may become a part of preoperative optimization for surgery
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93742
Program Number: S033
Presentation Session: Complex Abdominal Wall Hernia
Presentation Type: Podium