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Intraoperative Infection Prophylaxis In Tissue Expander Based Breast Reconstruction: Does Adding Povidone-Iodine Improve Outcomes?
Julie L. Cooper, BS1, Yash Kadakia, BA1, Austin Hembd, MD1, Ricardo Garza, BS1, Sami U. Khan, MD2, Sumeet S. Teotia, MD1, Nicholas T. Haddock, MD1.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2Stony Brook University, Stony Brook, NY, USA.

PURPOSE: Intraoperative antisepsis is necessary to prevent postoperative surgical site infections. While there are multiple antiseptic product options, there is data lacking comparing their efficacies. This study aims to compare two antiseptic regimens for efficacy.
METHODS: Retrospective chart review was performed on 200 patients who underwent bilateral tissue expander placement by two senior surgeons at a university hospital (August 2014 - June 2019) as part of immediate breast reconstruction following mastectomy by one of two senior breast surgeons at a university hospital. Each of the patient's breast wounds were treated for infection prophylaxis using one of two antiseptic regimens: povidone-iodine and antibiotic wash (regimen 1) or only antibiotic wash (regimen 2). Infection incidence, TE removal, return visits to the OR, and comorbidities were tracked between the two groups. Data was collected using a centralized REDCap database and analyses were performed using Microsoft Excel software.
RESULTS: There were no significant differences in outcomes amongst the two regimen groups, including infection incidence, number of patients with complications requiring return to the OR, and TE removal. There was no significant difference in incidence of diabetes or hypertension between the two groups. However, there was a significantly higher proportion of current/former smokers in the Regimen 2 group (p=3.0E-5, 21/61 compared to 14/139).
CONCLUSION: Both regimens result in similar patient outcomes, therefore, either is acceptable as a primary means of intraoperative infection prophylaxis. In the future, it is worth considering the economic impact of the two regimens to determine if one is significantly more cost-effective than another, and therefore would be preferred.


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