COST-ANALYSIS OF ANTIBIOTIC-PROPHYLAXIS IN CLEAN HEAD AND NECK-SURGERY

Objective: This study was undertaken to assess the excess cost of hosp italization accrued to patients who develop postoperative wound infect ion following neck dissection in which the wound was not exposed to se cretions from the upper aerodigestive tract. Design: A retrospective c ohort of patients who underwent ''clean'' neck dissection from 1976 to 1989 were evaluated. Antibiotic administration (yes or no), postopera tive wound infection (yes or no), and duration and cost of hospitaliza tion were assessed. Setting: All surgeries were performed in a univers ity medical center. Patients: All patients underwent neck dissection i n which the procedure was clean, ie, there was no exposure to secretio ns from the upper aerodigestive tract. Main Outcome Measures: Patients were assessed to determine administration of antibiotics (yes or no), development of postoperative wound infection (yes or no), and duratio n and cost of hospitalization. Results: Wound infection developed in 1 0 (10%) of 99 patients who did not receive antibiotics. Of 93 patients who received perioperative antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant. The type II (beta) error was greater than 0.2, suggesting that a significant d ifference may have been missed (false-negative) as a result of the sma ll number of patients studied. The excess cost accrued to each patient who developed a postoperative wound infection was in excess of $36 00 0 (1992 dollars). The cost of administration of antibiotic prophylaxis to 100 patients is less than this amount. Conclusion: The decision to withhold antibiotic prophylaxis should not be made in an effort to re duce hospital costs.