Trends of Intraoperative Antibiotic Prophylaxis for Thyroid and Parathyroid Surgery and Evaluation of Postoperative Outcomes

Sunday, October 18, 2026

8:24 AM - 8:30 AM PT

Location: West Exhibit Hall A, Learning Zone 3

Presenting Author(s)

Robert E. Africa, MD

Resident
The University of Texas Medical Branch
Galveston, TX, United States

Co-Author(s)

VT

Victoria Teoh, BBA

Medical Student
The University of Texas Medical Branch, United States
Shahrukh R. ali, MD

Shahrukh Ali
University of Texas Medical Branch
Richmond, TX, United States
Brian J. McKinnon, MD, MBA, MPH

Chair of Surgery
Meritus Health
Hagerstown, Maryland, United States
OC

Orly M. Coblens, MD

Associate Professor
The University of Texas Medical Branch
Galveston, Texas, United States
FM

Felix Maldonado Chapa, MD

Assistant Professor
The University of Texas Medical Branch, United States

Senior Author(s)

Viran J. Ranasinghe, MD

Assistant Professor
The University of Texas Medical Branch
Galveston, TX, United States

Disclosure(s):

Brian J. McKinnon, MD, MBA, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Viran J. Ranasinghe, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: No official guidelines exist for antibiotic prophylaxis in thyroid and parathyroid surgery. This study evaluates trends in its use relative to the publication of the Young Otolaryngologist Group of the International Federation of Otolaryngologic Societies (YO-IFOS) position paper on head and neck surgery antibiotic prophylaxis in 2019.

Methods: This multicenter, retrospective cohort study used de-identified data from 70 healthcare organizations in the TriNetX database from 2010 to 2024. Adults (≥ 18 years) who underwent thyroid or parathyroid surgery for benign disease were grouped on whether they did or did not receive antibiotic prophylaxis with cefazolin, ampicillin/sulbactam, or piperacillin/tazobactam. Two time periods (2010-2019 and 2019-2024) were analyzed to correspond with the publication of the key position paper. Trends in antibiotic prophylaxis were compared before and after the publication of this study by interrupted time series analysis in Statistical Analysis System (SAS) 9.4 (p > 0.05). Postoperative outcomes assessed 1 month after surgery included surgical site infection (SSI), Clostridium difficile (C. diff) infection, hematoma, and seroma, reported as relative risk (RR) with 95% confidence intervals (CI).

Results: Intraoperative antibiotic use during thyroid surgery increased by 2.08% per year before 2019, then slowed by 0.52% annually (p = 0.04). For parathyroid surgery, the rate of intraoperative antibiotic use increased by 1.93% per year, and it was similar after 2019 at 1.37% annually (p =0.09). Rates of surgical site infection, hematoma, and seroma were similar across groups for both procedures. C. diff infection rates were significantly higher in the antibiotic prophylaxis group prior to 2019 but not after 2019 for both thyroid surgery (RR: 2.47 [1.41–4.34] vs 1.47 [0.82–2.64]) and parathyroid surgery (RR: 1.71 [1.03–2.82] vs 1.60 [0.92–2.80]).

Conclusions: Increased antibiotic use before 2019 may be associated with increased risk of C. diff infection despite low SSI risk. After 2019, intraoperative prophylaxis decreased, but antibiotic use persisted despite low SSI risk.