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Once Is Not Enough: Withholding Postoperative Prophylactic Antibiotics in Prosthetic Breast Reconstruction Is Associated with an Increased Risk of Infection

Clayton, John L. M.D., Ph.D.; Bazakas, Andrea B.S.; Lee, Clara N. M.D., M.P.P.; Hultman, C. Scott M.D., M.B.A.; Halvorson, Eric G. M.D.

Plastic & Reconstructive Surgery: September 2012 - Volume 130 - Issue 3 - p 495–502
doi: 10.1097/PRS.0b013e31825dbefe
Breast: Original Articles
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Background: There has been a trend toward limiting perioperative prophylactic antibiotics, based on research not conducted in plastic surgery patients. The authors' university hospital instituted antibiotic prescribing guidelines based on the Surgical Care Improvement Project. An increased rate of surgical-site infections was noted in breast reconstruction patients. The authors sought to determine whether the change in antibiotic prophylaxis regimen affected rates of surgical-site infections.

Methods: A retrospective study compared patients undergoing breast reconstruction who received preoperative and postoperative prophylactic antibiotics with a group who received only a single dose of preoperative antibiotic. Type of reconstruction and known risk factors for implant infection were noted.

Results: Two hundred fifty patients were included: 116 in the pre–Surgical Care Improvement Project group and 134 in the Surgical Care Improvement Project group. The overall rate of surgical-site infections increased from 18.1 percent to 34.3 percent (p = 0.004). Infections requiring reoperation increased from 4.3 percent to 16.4 percent (p = 0.002). Multivariate logistic regression demonstrated that patients in the Surgical Care Improvement group were 4.74 times more likely to develop a surgical-site infection requiring reoperation (95 percent CI, 1.69 to 13.80). Obesity, history of radiation therapy, and reconstruction with tissue expanders were associated with increased rates of surgical-site infection requiring reoperation.

Conclusions: Withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of surgical-site infection, reoperation, and thus reconstructive failure. The optimal duration of postoperative prophylactic antibiotic use is the subject of future study.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Chapel Hill, N.C.

From the Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill.

Received for publication January 23, 2012; accepted March 23, 2012.

Presented at the 79th Annual Meeting of the American Society of Plastic Surgeons, in Toronto, Ontario, Canada, October 1 through 5, 2010, and the Annual Meeting of the North Carolina Society of Plastic Surgeons, in White Sulfur Springs, West Virginia, October 14 through 17, 2010.

Disclosure: The authors report no financial associations or funds received in the preparation of this article.

Eric G. Halvorson, M.D.; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, N.C. 27599-7195, eric_halvorson@med.unc.edu

©2012American Society of Plastic Surgeons