Abstract: Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction (Plastic Surgery 2014)

Saturday, October 11, 2014: 1:45 PM

Kerry E Drury, BA , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Steven T Lanier, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Nima Khavanin, BS , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Keith M Hume, MA , American Society of Plastic Surgeons, Arlington Heights, IL

Karol A Gutowski, MD , Department of Plastic Surgery, The Ohio State University, Columbus, OH

Brian P Thornton, MD, PhD , Kentucky Aesthetics & Plastic Surgery Institute, Louisville, KY

Nora M Hansen, MD , Division of Breast Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

Robert X Murphy, MD, MS , Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, PA

Neil A Fine, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

John YS Kim, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Presentation PDF file

E-Poster

Purpose: Though studies have shown that a majority of surgeons prescribe prolonged postoperative antibiotics following autologous breast reconstruction, evidence is lacking to support this practice. We analyzed data from the Tracking Operations & Outcomes for Plastic Surgeons (TOPS) database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection in autologous breast reconstruction.

Methods: The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. Secondary variables analyzed included patient age, body mass index (BMI), active smoking, diabetes, inpatient or outpatient admission status, and American Society of Anesthesiologists (ASA) class. The primary outcome variable of interest for this study was the presence of a surgical site infection (SSI) within 30-days of autologous breast reconstruction. SSIs included superficial incisional, deep incisional, and organ/space surgical site infections in keeping with CDC definitions. Cohort characteristics and 30-day outcomes were compared using χ2 and Fischer’s exact tests for categorical variables and Student T-tests for continuous variables. Multivariate logistic regression was utilized to control for confounders.

Results: A total of 1,036 patients met inclusion criteria for our study. 659 patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs. 2.92%, p = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling.

Conclusion: Our study represents the largest to date to examine the association between postoperative antibiotic duration and surgical site infection rate in autologous breast reconstruction. In accordance with previously published data from smaller studies, we did not find a statistically significant difference in the rate of surgical site infection between patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours.

25093 Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction