Evaluation of Antibiotic Prophylaxis in Rhinoplasty

Abstract

IMPORTANCE Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed. OBJECTIVE To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis. DATA SOURCES MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent. STUDY SELECTION Randomized clinical trials (RCTs) with adults (Ն18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1. DATA EXTRACTION AND SYNTHESIS Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model. MAIN OUTCOMES AND MEASURES Difference in infectious complication rate between groups. RESULTS A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86). CONCLUSIONS AND RELEVANCE This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty. LEVEL OF EVIDENCE 1.

Are Antibiotics Needed in Septorhinoplasty? An Evidence-Based Approach

“…Lastly, a recent systematic review and meta-analysis of randomized controlled trials (RCT) evaluated the antibiotic prophylaxis in rhinoplasty. 18 Five RCTs were included with a pooled study sample of 589 patients. The results demonstrated that there is no significant difference in postoperative infections between preoperative and postoperative antibiotics, with a pooled risk ratio of 0.92 (95% confidence interval [CI], 0.35-2.43, p ¼ 0.86).…”

Complications in Facial Esthetic Surgery

“…51,52 While perioperative antibiotic use during rhinoplasty is largely surgeon preference, review of the data available in the literature seems to support that perioperative antibiotic use does not improve outcomes. 53,54…”

Polysiloxane Nanofilaments Infused with Silicone Oil Prevent Bacterial Adhesion and Suppress Thrombosis on Intranasal Splints

“…Intranasal septal splints are commonly used after septoplasty and rhinoplasty surgery to prevent postoperative complications such as bleeding, synechia, and septal hematoma formation while enabling nasal breathing and stabilizing the newly constructed nasal septum. − Despite their widespread use, these implants are highly prone to biofilm formation, with an incidence rate of up to 12%, which can lead to life-threatening infections such as toxic shock syndrome. , Although not as frequent as bacterial infections, cavernous sinus thrombosis is yet another complication associated with intranasal splints. Antibiotic prophylaxis is often prescribed to reduce the risk of postoperative infections, and while its effectiveness is controversial, many surgeons choose to continue prophylactic administration of antibiotics postoperation for fear of infection. ,, This practice increases the risk of evolution of resistance in wild-type strains in the nasal cavity postoperation, and besides, it does little to prevent other device-associated complications such as thrombosis. , Due to these limitations, there is an immediate need for the development of new methods to improve the safety and biocompatibility of intranasal splints. To our knowledge, no studies have investigated the application of new surface-coating strategies to enhance the hemocompatibility and antifouling properties of these medical implants.…”

“…Antibiotic prophylaxis is often prescribed to reduce the risk of postoperative infections, and while its effectiveness is controversial, many surgeons choose to continue prophylactic administration of antibiotics postoperation for fear of infection. 11,13,14 This practice increases the risk of evolution of resistance in wild-type strains in the nasal cavity postoperation, and besides, it does little to prevent other device-associated complications such as thrombosis. 8,15 Due to these limitations, there is an immediate need for the development of new methods to improve the safety and biocompatibility of intranasal splints.…”