Plastic Surgery Research Council

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Postoperative Prophylactic Antibiotics Is Not Necessary in Tissue-Expander Breast Reconstruction: A Single-Institution's Change in Protocol
Kanad Ghosh, BA1, Jocellie Marquez, MD2, Kailash Kapadia, BS1, Austin Ferrier, BS1, Christopher Medrano, BA1, William Marmor, BS1, Gurtej Singh, PhD2, Vasileios Vasilakis, MD3, Tara Huston, MD, FACS2, Jason Ganz, MD, FACS2, Sami Khan, MD2, Alexander Dagum, MD2, Duc Bui, MD2.
1Stony Brook University School of Medicine, Stony Brook, NY, USA, 2Stony Brook University Hospital, Stony Brook, NY, USA, 3Long Island Plastic Surgery Group, Garden City, NY, USA.

PURPOSE: Plastic surgeons prescribe discharge antibiotics due to concern of surgical site infections (SSIs) in tissue expander-based immediate breast reconstructions (TE-IBRs). In 2016, our institution published a randomized clinical trial (RCT) which found no significant difference between short (24-hour perioperative antibiotics) versus extended (24-hour perioperative plus discharge oral antibiotics until drain removal) regimens. This prompted a shift towards the short regimen among the majority of plastic surgeons at our institution. This study evaluates complication rates between both antibiotic protocols incorporating data since the RCT.
METHODS: A retrospective review of TE-IBRs from 2001 to 2017 at a single-institution was performed; cases during and up to 1-year after RCT were excluded. Demographics, comorbidities, operative details, and complications were identified. Minimum follow-up was at least one year.
RESULTS: Four-hundred and forty-seven patients met inclusion criteria; Group I (n=287) received extended antibiotic regimen and Group II (n=160) received short antibiotic protocol. Infection (12% vs. 12%, p=0.890), seroma (10% vs. 6%, p=0.068), hematoma (2% vs. 3%, p=0.794), or skin necrosis (7% vs. 5%, p=0.125), implant loss (5% vs 2%, p=0.014) and capsular contracture (3% vs. <1%, p=0.013) rates between Groups I and II, respectively, were analyzed.
CONCLUSION: We found no difference in infection rate but statistically significant differences in implant loss and capsular contracture the two groups. This study validates that the RCT-guided change towards short-duration antibiotics has not increased complication rates at our institution while improving outcomes. Future studies are needed in the form of a multiple-institution RCT.


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