One of the many benefits of working at an academic medical center is the opportunity to work with residents and fellows, where I am often explaining the research evidence supporting the decisions I make in taking care of patients. In every field of medicine, there are decisions that we make in the absence of perfect research evidence, and we must rely on our own experience. For my entire career, I have generally used antibiotics at the time of surgery and for a few days after surgery whenever I perform soft palate surgery. Even though serious infection after soft palate surgery is almost impossible, my experience was that antibiotics reduced swelling during the recovery process and decreased the needs for pain medication.
Throughout my career, I have been aware of the concerns about the over-prescription of antibiotics. There are numerous downsides of antibiotics, whether the costs, risks to the health of the individual patient, or contribution to the development of antibiotic-resistant bacteria. Studies have shown that antibiotics after tonsillectomy alone are not helpful, especially in children where antibiotic use has decreased dramatically over the years. However, I felt that these studies were based on tonsillectomy performed for conditions like tonsillitis rather than obstructive sleep apnea, so I was never convinced that they applied to my sleep apnea patients. I always felt uneasy – almost like a stubborn elephant, unwilling to change with the times – overriding these concerns based on my own subjective experience without objective scientific research as a foundation.
Breaking news: antibiotics after surgery are associated with benefits!
In the September 2021 issue of the medical journal Otolaryngology – Head and Neck Surgery, Mohammed Abdelwahab, MD, MD, Robson Capasso, MD, and their team at Stanford University asked whether antibiotics given within two weeks of surgery (presumably to take after surgery) or within one week after surgery were associated with complications. In a study based on a large private insurance database including almost 40,000 soft palate surgeries from 2007-15, they had the following findings:
- The risk of postoperative bleeding was 5%, becoming more common over this time period
- Antibiotics were associated with lower risks of bleeding across multiple procedures types (palate surgery with or without other procedures performed at the same time)
- Antibiotics were associated with lower odds of other serious complications
I knew I was right…
It is nice to see that I have not been doing something harmful to my patients, solely due to my stubbornness. Truth be told, I cannot take credit for knowing that antibiotics would be associated with the lower odds of bleeding. My experience that antibiotics may lower pain after surgery was not examined in this study, and the good news is that bleeding is uncommon enough that it would be hard to perform this study in any single center. All credit to the authors for identifying this database as well-suited to their innovative study.
At least now I can prescribe those antibiotics based on research (lower odds of bleeding) and my experience (decreased pain).