(1251) Postdischarge Versus Inpatient-Only Antibiotics After Endoscopic Pituitary Surgery: Infectious and Utilization Outcomes

Introduction: The role of post-discharge antibiotics after endoscopic endonasal pituitary surgery is unclear and practice varies from extended oral courses to limiting prophylaxis to the inpatient stay. Prolonged outpatient regimens are intended to reduce infectious complications but increase cost and contribute to antimicrobial resistance. This study compared outcomes between patients receiving 7‑day oral antibiotics after discharge and those receiving antibiotics only during hospitalization.

Methods: This retrospective cohort included patients undergoing endoscopic endonasal pituitary surgery at a tertiary center from 2024–2025. Patients received a 7-day post-discharge oral antibiotic course or inpatient‑only antibiotics. Outcomes were 90-day infection‑related Emergency Department (ED) visits, postoperative (post-op) meningitis, post-op cerebrospinal fluid (CSF) leak, 30-day readmission and number of post-op patient messages/phone calls received.

Results: A preliminary analysis included 89 patients, 63 received post-discharge antibiotics, 26 did not. The mean tumor volume was 1.78 cm³ (SD 3.61) in the post-discharge antibiotic group and 3.21 cm³ (SD 5.18) in the post-discharge without antibiotic group, with similar mean ages (51 vs 52 years, both SD 15). There were no significant differences between groups in rates of post-op meningitis or CSF leak, 90-day ED visits or readmissions for infection, or the number of post-op messages/phone calls after adjustment for nasal packing type, and intraoperative CSF leak (p>0.05).

Conclusions: In this preliminary cohort, post-discharge antibiotics did not demonstrate a measurable reduction in post-op infectious complications or 90-day utilization outcomes, suggesting limited to no benefit of routine post-discharge antibiotic use following endonasal pituitary surgery.