Prophylactic i.v. antibiotics in functional endoscopic sinus surgery: Trends and attitudes of the American Rhinologic Society membership

Background: Use of antibiotic prophylaxis in otolaryngology-head and neck surgery is a practice that exhibits significant variation among practitioners, and trends vary by subspecialties within the field. The objective of this study was to assess these habits among otolaryngologists with special interest or experience in functional endoscopic sinus surgery (FESS). Methods: Attendees of the 2008 Annual Meeting of the American Rhinologic Society were surveyed regarding practice patterns and attitudes concerning the use of prophylactic i.v. antibiotics in FESS. Results: Surveys were returned from 49 attendees, and within this sample, i.v. antibiotic prophylaxis was used by 28 (57%) and was not in 21 (43%). Among those who used prophylaxis, only 2128 (7%) did so because they felt there was strong evidence to support such a practice, while 26128 (93%) used prophylactic antibiotics despite the opinion that there is no solid evidence in support of this. The most common antibiotic chosen empirically was a cephalosporin (25128; 89%). There was no significant difference between those who did and did not use prophylactic i.v. antibiotics with regard to number of years in practice or practice situation (full-time academic, academic affiliated private, solo private, and group private). Conclusion: Opinion of the respondents suggests there is no solid empiric evidence supporting the use of prophylactic i.v. antibiotics in FESS. Nonetheless, this practice is more common than not. Possible explanations for these observations are explored in the context of new pay for performance quality measures. (Am J Rhinol Allergy 23, 448-450, 2009; doi: 10.2500/ajra.2009.23.3349)