Department of Surgery, Link Building, Aga Khan University, Karachi, Pakistan.
Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
Ann Surg Oncol. 2022 Oct;29(10):6314-6322. doi: 10.1245/s10434-022-12223-7. Epub 2022 Jul 25.
Surgical site infections after breast surgery range from 1 to 16%. Both the American Society of Breast Surgeons (ASBrS) and the American Association of Plastic Surgeons guidelines lack clarity on postoperative antibiotic prophylaxis (AP) after mastectomy. We surveyed the ASBrS membership to understand their practice patterns of AP after mastectomy and familiarity with ASBrS guidelines.
A self-designed, 19-question survey was emailed to all 2934 ASBrS members. Information was obtained on the participants' training, familiarity with ASBrS guidelines, and practices of prescribing perioperative AP after mastectomy with/without reconstruction and with indwelling drains.
In total, 556 (19%) responses were analyzed. Half were fellowship-trained breast surgeons/surgical oncologists (50.2%), with 55.6% having practiced for > 15 years and 66.9% in community/private practice. Only 53.6% reported familiarity with ASBrS guidelines for perioperative AP. Most (> 90%) surgeons reported "always" placing drains after mastectomy and "always" prescribing preoperative AP. Postoperatively, preference for continuing AP in cases with drains in place varied by procedure: 7.7% when no reconstruction, 29.1% when autologous-only, and 52.5% when implant reconstruction. Academic surgeons were less likely than surgeons in community/private practice to continue postoperative AP, whether for the duration of indwelling drains (5.1% versus 9.4%) or even till 7 days postoperatively (0.6% versus 3.2%) (p < 0.05).
Surgeons uniformly adhere to ASBrS guidelines for preoperative AP. However, there is wide variation in AP postoperatively in patients with/without reconstruction and with indwelling drains. Our results highlight the need for high-quality evidence based on which guidelines must be updated, and the need to familiarize surgeons with current guidelines.
乳房手术后的手术部位感染率为 1%至 16%。美国乳腺外科学会（ASBrS）和美国整形外科学会的指南都没有明确规定乳房切除术后的术后抗生素预防（AP）。我们调查了 ASBrS 的会员，以了解他们在乳房切除术后使用 AP 的实践模式以及对 ASBrS 指南的熟悉程度。
我们向所有 2934 名 ASBrS 会员发送了一份自行设计的 19 个问题的调查。获得了参与者的培训、对 ASBrS 指南的熟悉程度以及在乳房切除术后有无重建和留置引流管的情况下预防性使用围手术期 AP 的实践信息。
共分析了 556 份（19%）回复。其中一半是乳腺外科/肿瘤外科的研究员（50.2%），55.6%的人有超过 15 年的从业经验，66.9%的人在社区/私人诊所工作。只有 53.6%的人报告熟悉 ASBrS 关于围手术期 AP 的指南。大多数（>90%）外科医生报告在乳房切除术后“总是”放置引流管，并“总是”开具术前 AP。术后，在有引流管的情况下继续使用 AP 的偏好因手术方式而异：无重建时为 7.7%，仅自体组织重建时为 29.1%，植入物重建时为 52.5%。与社区/私人诊所的外科医生相比，学术外科医生不太可能在有或没有重建以及有留置引流管的情况下继续术后 AP，无论是持续使用引流管（5.1%比 9.4%）还是甚至术后 7 天（0.6%比 3.2%）（p<0.05）。
外科医生普遍遵守 ASBrS 关于术前 AP 的指南。然而，在有/无重建和留置引流管的患者中，术后 AP 存在广泛的差异。我们的结果强调了需要高质量的证据，根据这些证据必须更新指南，并使外科医生熟悉当前的指南。
