Mankowski Peter, Cherukupalli Abhiram, Slater Karen, Carr Nick
Division of Plastic Surgery, University of British Columbia, Vancouver British Columbia, Canada.
Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada.
Plast Surg (Oakv). 2021 May;29(2):132-138. doi: 10.1177/2292550321997005. Epub 2021 Mar 2.
The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis.
A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use.
Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use.
Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.
使用适当的术前抗生素预防措施可降低手术部位感染（SSI）的风险；然而，整形手术程序的多样性使得确保针对每种独特手术类型正确使用抗生素具有挑战性。目前，整形外科医生缺乏一套连贯且全面的基于证据的指南（EBG）用于手术预防。我们旨在剖析不列颠哥伦比亚省整形外科医生围手术期抗生素的处方模式，以调查其是否与已发表的建议一致。在此过程中，我们旨在确定手术预防中抗生素过度处方的风险因素。
进行了一项文献综述，以确定常见整形手术中抗生素预防使用的EBG。同时，对省级整形外科住院医师、研究员、学术和社区整形外科医生进行了一项调查，以确定他们的抗生素预防处方习惯。然后将这些结果与我们综述中确定的建议进行比较。确定了省级整形外科界对38种手术情况的当前EBG的依从性，以确定哪些临床因素和手术类型与无依据的抗生素使用相关。
在文献中，38类被调查的整形手术操作中有31类有使用预防性抗生素的EBG。当手术程序有EBG时，19.5%的整形手术实习生和21.9%的执业整形外科医生遵循了推荐的预防措施使用。手部手术对EBG的平均依从率为59.1%，乳房手术为24.1%，颅面手术为23.9%。乳房重建手术和污染的颅面手术与EBG依从性的显著降低相关，导致抗生素使用过量。
即使存在抗生素预防的循证建议，整形外科医生根据其报告的处方习惯表现出不同的依从性。EBG依从性低的手术程序可能反映了执业外科医生的风险规避行为，并突出了在这些临床情况下加强对抗生素预防益处教育的重要性。
