Antibiotics Prophylaxis in Anterior Skull Base Surgery: A National Survey

Abstract Background: In the anterior skull base surgery (ASBS), there is a potential connection between the sinonasal mucosa and the intracranial space, and a possibility of infecting the sterile intracranial space. The latest international consensus statement of the American Rhinology Society (ARS) did not endorse or oppose prescribing prophylactic antibiotics in ASBS, leaving the decision entirely to the surgeon. In this study, we aim to survey otolaryngologists and neurosurgeons in Saudi Arabia to uncover the current practices and patterns of perioperative antibiotic use in ASBS and the factors that influence their prescription. Methods: A 12-sections online-based questionnaire was distributed to rhinologist and neurosurgeons practicing in Saudi Arabia through social media platforms. Demographical characteristics of the respondents were collected, such as their type of training, their geographical location, the average number of skull base surgeries they perform per year and the type of the operation. We also assessed the type of antibiotics frequently used and the frequency and patterns of prescribing them. Results: The sample comprised 47 surgeons based in Saudi, with 53.2% being rhinologist and 46.8% being neurosurgeons. The type of operation varied, with 53.7% performing endoscopic operations, 14.9% performing open operations, and 31.9% performing both. The type of operation showed a significant difference regarding preoperative antibiotics description ( P = 0.004). In addition, neurosurgeons significantly prescribed preoperative antibiotics compared to rhinologists ( P = 0.001). Furthermore, preoperative antibiotics description differed significantly with previous skull base training experience ( P = 0.007). The number of skull base surgeries performed per year varied, with the majority performing between 0–10 (38.3%) and 11–25 (40.4%) surgeries. Conclusion: To date, no guidelines exists in regards to prescribing prophylactic antibiotics in ASBS, and the decision is entirely left for the surgeon to decide whether to prescribe them or not, we conducted a national survey targeting skull base surgeons in Saudi to uncover their the current practices and patterns of perioperative antibiotic use in ASBS.