Perioperative Antibiotic Usage by Facial Plastic Surgeons

Grunebaum, Lisa D.; Reiter, David

doi:10.1001/archfaci.8.2.88

Cited by 17 publications

(14 citation statements)

References 13 publications

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“…Despite the current lack of evidence, the fear of SSIs is still considerably larger than the fear of possible adverse effects or antimicrobial resistance resulting from prolonged antibiotic administration. [3][4][5][6][7] As a result, antibiotic prophylaxis regimens are often prolonged when they might not be necessary. [3][4][5][6][7] However, in light of the antimicrobial resistance issue, the increased risk of serious postoperative adverse effects, and additional pharmaceutical costs, it is becoming extremely difficult to ignore the need for solid evidence on the ideal duration of postoperative antibiotic prophylaxis.…”

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confidence: 99%

“…[3][4][5][6][7] As a result, antibiotic prophylaxis regimens are often prolonged when they might not be necessary. [3][4][5][6][7] However, in light of the antimicrobial resistance issue, the increased risk of serious postoperative adverse effects, and additional pharmaceutical costs, it is becoming extremely difficult to ignore the need for solid evidence on the ideal duration of postoperative antibiotic prophylaxis. The aim of this study is to systematically review the literature and perform a metaanalysis focused on the association of SSIs with use of shortcourse antibiotic prophylaxis (≤24 hours) vs extendedcourse antibiotic prophylaxis (≥72 hours) after ENT and OMF surgery.…”

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confidence: 99%

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Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery

Oppelaar

Zijtveld

Kuipers

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Antibiotic prophylaxis is widely used after surgical procedures operating on the mucosal tissues of the aerodigestive tract, but the optimal duration of these prophylactic therapies is often unclear. OBJECTIVE To compare short-course antibiotic prophylaxis (Յ24 hours) vs extended-course antibiotic prophylaxis (Ն72 hours) after ear, nose, throat, and oral and maxillofacial surgery. DATA SOURCES AND STUDY SELECTION Literature searches of PubMed were completed in October 2017 and included prospective trials that compared antibiotic prophylaxis courses of 24 hours or less vs 72 hours or more after ear, nose, throat, and oral and maxillofacial surgery. Some studies were also handpicked from reference lists of studies found with the initial search terms. All analysis was performed between September 2017 and October 2018. DATA EXTRACTION AND SYNTHESIS All review stages were conducted in consensus by 2 reviewers. Data extraction and study quality assessment were performed with the Cochrane data extraction form and the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. The fixed-effects Mantel-Haenszel method was used for meta-analysis. MAIN OUTCOMES AND MEASURES Relative risk (RR) of surgical site infections, microbial origins of surgical site infections, adverse events, duration of hospital stay, and treatment costs. RESULTS Included in the meta-analysis were 21 articles with a cumulative 1974 patients. In patients receiving 24 hours or shorter vs 72 hours or longer antibiotic prophylaxis regimens, no significant difference was found in the occurrence of postoperative infections in the pooled population (RR, 0.90; 95% CI, 0.67-1.19), or in the ear, nose, throat (RR, 0.89; 95% CI, 0.54-1.45), and oral and maxillofacial populations (RR, 0.88; 95% CI, 0.63-1.21), separately. No heterogeneity was observed overall or in the subgroups. Patients receiving extended-course antibiotic prophylaxis were significantly more likely to develop adverse events unrelated to the surgical site (RR, 2.40; 95% CI, 1.20-3.54). CONCLUSIONS AND RELEVANCE No difference was found in the occurrence of postoperative infections between short-course and extended-course antibiotic prophylaxis after ear, nose, throat, and oral and maxillofacial surgery. Therefore, a short course of antibiotic prophylaxis is recommended unless documented conditions are present that would be best treated with an extended course. Using short-course antibiotics could avoid additional adverse events, antibiotic resistance development, and higher hospital costs. Future research should focus on identifying risk groups that might benefit from prolonged prophylaxis.

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confidence: 99%

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confidence: 99%

Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery

Oppelaar

Zijtveld

Kuipers

et al. 2019

JAMA Otolaryngol Head Neck Surg

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“…Several surveys have shown that a majority of plastic surgeons use antibiotics for facial plastic surgical procedures, although few studies support this. 2 , 8 , 32 Albeit postoperative infections are rare after plastic surgery, plastic surgeons most commonly overprescribe antibiotics as cosmetic infections can seriously affect the aesthetic outcome, which may not be as big of a concern in noncosmetic operations. Given that overusing antibiotics in rhinoplasty and septorhinoplasty cases is more the norm, a behavior change must occur in surgeons to be a part of the solution in decreasing AMR.…”

Section: Discussionmentioning

confidence: 99%

“…The WHO and rhinoplasty guidelines recommend antibiotics not be used for > 24 hours postoperatively, as is often done, due to a low risk of infection. 12 , 15 , 31 Grunebaum and Reiter 32 found that 49% of surgeons use antibiotics postoperatively for > 24 hours. Another survey noted that of 440 surgeons using antibiotics, 31% used antibiotics for > 4 days after rhinoplasty.…”

Section: Role Of Postoperative Antibioticsmentioning

confidence: 99%

The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?—A Review

Kullar

Frisenda

Nassif

2018

Plastic and Reconstructive Surgery - Global Open

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Background:With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology—Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty.Methods:The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics.Results:Ten studies met criteria. Studies evaluating antibiotics perioperatively showed similar infection and/or bacteremia rates (0–13.3%) in those receiving or not receiving antibiotics. No patients experienced significant local/systemic infections regardless of antibiotic use. In the 3 studies evaluating antibiotics postoperatively, antibiotics decreased the infection rate from 27% to 8% in complex revision cases. In a study evaluating postoperative antibiotics in noncomplex cases, there were no significant differences in infection rates between those receiving only a preoperative dose and those receiving preoperative in addition to 7 days of postoperative antibiotics, with the latter experiencing higher rates of antibiotic-related adverse events and costs.Conclusions:Peri- and postoperative antibiotics in noncomplex rhinoplasty and septorhinoplasty are not beneficial in decreasing infection risk. Antibiotics, with a first-generation cephalosporin such as cefazolin (non–β-lactam, such as clindamycin, if β-lactam allergy), should be considered in patients with comorbidities/undergoing complex surgery. If perioperative antibiotics are used, antibiotics should be administered within 1 hour of incision and discontinued within 24 hours of the operation. Further research is warranted to evaluate the optimal duration of postoperative antibiotics in complex cases.

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“…2,3 Because of this concern, despite the generally low incidence of SSIs in facial plastic surgery procedures, many surveyed clinicians prescribe postoperative antibiotics for SSI prophylaxis. 2,4,5 However, the risk of infection must be balanced with the risks of antibiotic use such as antibiotic resistance and superinfection. 6 Therefore, it is essential to understand the current literature regarding evidence-based infection prevention, as well as areas where more research is needed.…”

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Postoperative Antibiotic Use Among Patients Undergoing Functional Facial Plastic and Reconstructive Surgery

Olds

Spataro

et al. 2019

JAMA Facial Plast Surg

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Best practices for antibiotic use after facial plastic and reconstructive procedures have been the subject of much debate, and there is a need for large-scale data to guide further development of evidence-based guidelines for antibiotic use in this setting.OBJECTIVE To assess patterns of postoperative antibiotic prescriptions and infection rates after nasal and oculoplastic procedures. DESIGN, SETTING, AND PARTICIPANTSA retrospective population-based cohort study was conducted using IBM MarketScan Commercial and Medicare Supplemental research databases of 294 039 patients who underwent facial plastic surgery procedures between January 1, 2007, and December 31, 2015. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year before and after the procedure, or underwent additional procedures on the surgery date of interest. Statistical analysis was performed from January 1, 2007, to December 31, 2016. MAIN OUTCOMES AND MEASURESPrimary outcomes were antibiotic prescription patterns in the immediate postoperative period and rates of postoperative infectious complications. Explanatory variables included patient demographics, procedure type, and relevant comorbidities, which were used in multivariable logistic regression analysis. RESULTSOf the 294 039 patients who met inclusion criteria (55.9% women and 44.1% men; mean [SD] age, 54.0 [18.6 years]), 45.2% filled prescriptions for postoperative antibiotics, including 55.3% of patients undergoing nasal procedures and 14.7% of patients undergoing oculoplastic procedures. Superficial surgical site infections occurred in 1.6% of patients, while deep surgical site infections occurred in 0.3% of patients. On multivariable logistic regression, patients receiving postoperative antibiotics were at significantly decreased risk of postoperative infections (nasal procedures: adjusted odds ratio [aOR], 0.144 [95% CI, 0.102-0.203]; oculoplastic procedures: aOR, 0.254 [95% CI, 0.104-0.622]) compared with those who did not receive postoperative antibiotics. Increased duration of postoperative antibiotics was not associated with reduced rates of infectious complications (nasal procedures: aOR, 1.000 [95% CI, 0.978-1.022]; oculoplastic procedures: aOR, 1.024 [95% CI, 0.959-01.092]). Despite being more likely to experience postoperative infections, patients with a history of tobacco use (aOR, 0.806 [95% CI, 0.747-0.870]), immunodeficiency (aOR, 0.774 [95% CI, 0.737-0.813]), or type 1 or 2 diabetes (aOR, 0.810 [95% CI, 0.772-0.850]) were less likely to be prescribed antibiotics than those without these conditions.CONCLUSIONS AND RELEVANCE Postoperative antibiotic prescriptions were associated with reduced rates of infections after facial plastic surgery. This study highlights the role of population-level data in the development of best practices for postoperative antibiotic use and identifies the need for additional examination of antibiotic use patterns and recommendations for populations at increased risk for postoperative wound infection.

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Perioperative Antibiotic Usage by Facial Plastic Surgeons

Cited by 17 publications

References 13 publications

Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery

Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery

The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?—A Review

Postoperative Antibiotic Use Among Patients Undergoing Functional Facial Plastic and Reconstructive Surgery

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