Perioperative Antibiotic Use in Head and Neck Surgery
8 affiliations
- 1Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany
- 2Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- 3Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- 4Department of Otorhinolaryngology, Head and Neck Surgery, Charité University Medicine, Berlin, Germany
- 5Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
- 6Oberhavel-Kliniken GmbH, Klinik Hennigsdorf, Hennigsdorf, Germany
- 7Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- 8Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
Abstract
Importance: Perioperative antibiotic prophylaxis in head and neck surgery remains poorly standardized internationally, despite evidence supporting short-course regimens and showing no benefit in low-risk procedures. Contemporary international data on prescribing practice are limited.
Objectives: To characterize international patterns of perioperative antibiotic use in endocrine and oncologic head and neck surgery and to identify discrepancies between reported practice and evidence-based recommendations.
Design, Setting, and Participants: In this survey study, a cross-sectional survey was distributed electronically between October 1, 2024, and December 31, 2025, through national and international professional societies. Respondents were classified by country of practice into Europe, North America, and rest of world. Data were analyzed in June 2026.
Main Outcomes and Measures: Routine antibiotic use, agent selection, and duration of prophylaxis across 6 procedure categories (conventional thyroidectomy, completion thyroidectomy, complex thyroidectomy, low-risk head and neck squamous cell carcinoma [HNSCC], low-complexity HNSCC, and complex clean-contaminated HNSCC). Secondary outcomes were departmental guideline availability and circumstances prompting antibiotic use.
Results: Of 468 respondents (310 of 419 [74%] with available data reported male sex or gender, 32 of 432 [82%] otolaryngologists–head and neck surgeons and 283 of 431 [66%] in academic practice), routine antibiotic use for conventional thyroidectomy was reported by 12% (95% CI, 8%-19%) of European, 35% (95% CI, 27%-44%) of North American, and 56% (95% CI, 39%-71%) of rest of world respondents. For clean-contaminated HNSCC, prophylaxis use ranged from 93% to 99%, with aminopenicillin plus a β-lactamase inhibitor preferred in Europe (66%) and North America (64%); cefazolin predominated in North America (47%) and cefuroxime in Europe (31%). For low-complexity clean-contaminated procedures, 24-hour regimens were reported by 43% (95% CI, 34%–53%) of North American vs 11% (95% CI, 7%–16%) of European respondents, whereas 7-day courses were reported by 23% (95% CI, 17%–29%) of European vs 8% (95% CI, 4%–15%) of North American respondents. Departmental HNSCC guidelines were more available in Europe than North America (83% vs 38%).
Conclusions and Relevance: In this survey study of 468 head and neck surgeons, perioperative antibiotic prescribing was heterogeneous internationally, with routine use in clean procedures and prolonged regimens for clean-contaminated surgery. Departmental guideline availability did not correspond to shorter reported prophylaxis duration, suggesting that implementation rather than guideline existence may be the target for antimicrobial stewardship.
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BibTeX
@article{blaurock2026perioperative,
title = {{Perioperative Antibiotic Use in Head and Neck Surgery}},
author = {Markus Blaurock and Petr Szturz and Simon Andreas Mueller and Michael Knoke and Nadine Höpfner and Nils-Olaf Hübner and Johanna Inhestern and Elena Colombo and Chia-Jung Busch and Anastasios Maniakas},
journal = {JAMA Network Open},
year = {2026},
month = nov,
doi = {10.1001/jamanetworkopen.2026.42922},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856343},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perioperative Antibiotic Use in Head and Neck Surgery
AU - Markus Blaurock
AU - Petr Szturz
AU - Simon Andreas Mueller
AU - Michael Knoke
AU - Nadine Höpfner
AU - Nils-Olaf Hübner
AU - Johanna Inhestern
AU - Elena Colombo
AU - Chia-Jung Busch
AU - Anastasios Maniakas
PY - 2026
DA - 2026/11/09
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.42922
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856343
AB - Importance: Perioperative antibiotic prophylaxis in head and neck surgery remains poorly standardized internationally, despite evidence supporting short-course regimens and showing no benefit in low-risk procedures. Contemporary international data on prescribing practice are limited. Objectives: To characterize international patterns of perioperative antibiotic use in endocrine and oncologic head and neck surgery and to identify discrepancies between reported practice and evidence-based recommendations. Design, Setting, and Participants: In this survey study, a cross-sectional survey was distributed electronically between October 1, 2024, and December 31, 2025, through national and international professional societies. Respondents were classified by country of practice into Europe, North America, and rest of world. Data were analyzed in June 2026. Main Outcomes and Measures: Routine antibiotic use, agent selection, and duration of prophylaxis across 6 procedure categories (conventional thyroidectomy, completion thyroidectomy, complex thyroidectomy, low-risk head and neck squamous cell carcinoma [HNSCC], low-complexity HNSCC, and complex clean-contaminated HNSCC). Secondary outcomes were departmental guideline availability and circumstances prompting antibiotic use. Results: Of 468 respondents (310 of 419 [74%] with available data reported male sex or gender, 32 of 432 [82%] otolaryngologists–head and neck surgeons and 283 of 431 [66%] in academic practice), routine antibiotic use for conventional thyroidectomy was reported by 12% (95% CI, 8%-19%) of European, 35% (95% CI, 27%-44%) of North American, and 56% (95% CI, 39%-71%) of rest of world respondents. For clean-contaminated HNSCC, prophylaxis use ranged from 93% to 99%, with aminopenicillin plus a β-lactamase inhibitor preferred in Europe (66%) and North America (64%); cefazolin predominated in North America (47%) and cefuroxime in Europe (31%). For low-complexity clean-contaminated procedures, 24-hour regimens were reported by 43% (95% CI, 34%–53%) of North American vs 11% (95% CI, 7%–16%) of European respondents, whereas 7-day courses were reported by 23% (95% CI, 17%–29%) of European vs 8% (95% CI, 4%–15%) of North American respondents. Departmental HNSCC guidelines were more available in Europe than North America (83% vs 38%). Conclusions and Relevance: In this survey study of 468 head and neck surgeons, perioperative antibiotic prescribing was heterogeneous internationally, with routine use in clean procedures and prolonged regimens for clean-contaminated surgery. Departmental guideline availability did not correspond to shorter reported prophylaxis duration, suggesting that implementation rather than guideline existence may be the target for antimicrobial stewardship.
SN - 2574-3805
ER -