Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Breast Cancer. 2023 Apr;23(3):e103-e108. doi: 10.1016/j.clbc.2022.12.019. Epub 2022 Dec 30.
The current standard of practice in implant-based breast reconstruction is irrigation of the mastectomy pocket with antimicrobial solution before implant placement. Prior to being banned and formally recalled in January 2020, bacitracin was a very commonly utilized antibiotic. This study characterizes the effects of the national bacitracin ban on implant-based breast reconstruction infection rates by using a nationwide database to compare complication rates before and after bacitracin was banned.
The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried retrospectively for all patients who underwent implant-based breast reconstruction before the bacitracin ban (2012-2019) and afterwards (2020). Demographics, comorbidities, and complications were collected. Univariate analysis and multivariate analysis were conducted to determine if there were significant changes in wound complications, local wound infections, and systemic infections between the 2 case-control matched cohorts.
A total of 37,126 patients were in the pre-ban cohort and 6333 patients were in the post-ban cohort. Before matching, there were significant differences in race distribution, BMI, ASA class, inpatient vs. outpatient status, preoperative smoking, and preoperative diabetes mellitus (all P < .05). After case-control matching, there were 6313 patients in each cohort. Univariate analysis revealed differences in postoperative superficial and organ space surgical site infection, wound complications/infections, all cause complications, and reoperations (all P < .05). Multivariate analysis showed that patients who underwent breast reconstruction before the ban had decreased odds of having wound infections, related infections, all cause complications, and reoperations (all P < .05).
This study provides a macroscopic view into the effects of the formal injectable bacitracin ban on breast reconstruction outcomes. Patients who underwent implant-based breast reconstruction after the ban of injectable bacitracin had higher odds of developing wound infections, related infections, and reoperations. More study into suitable alternatives to injectable bacitracin for surgical site antimicrobial irrigation is warranted.
在基于植入物的乳房重建中，目前的标准做法是在植入物放置前用抗菌溶液冲洗乳房切除术腔。在 2020 年 1 月被禁止和正式召回之前，杆菌肽是一种非常常用的抗生素。本研究通过使用全国性数据库比较杆菌肽被禁止前后的并发症发生率，来描述全国范围内禁止杆菌肽对基于植入物的乳房重建感染率的影响。
回顾性地查询美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库中所有在杆菌肽禁令之前（2012-2019 年）和之后（2020 年）接受基于植入物的乳房重建的患者。收集了人口统计学、合并症和并发症。进行了单变量分析和多变量分析，以确定在这 2 个病例对照匹配队列之间，伤口并发症、局部伤口感染和全身感染是否有显著变化。
共有 37126 例患者在禁令前队列，6333 例患者在禁令后队列。在匹配之前，种族分布、BMI、ASA 分级、住院与门诊状态、术前吸烟和术前糖尿病有显著差异（均 P <.05）。病例对照匹配后，每个队列各有 6313 例患者。单变量分析显示，术后浅表和器官间隙手术部位感染、伤口并发症/感染、所有原因并发症和再次手术有差异（均 P <.05）。多变量分析显示，在禁令前接受乳房重建的患者发生伤口感染、相关感染、所有原因并发症和再次手术的几率降低（均 P <.05）。
本研究从宏观角度探讨了正式禁止注射用杆菌肽对乳房重建结果的影响。禁令后接受基于植入物的乳房重建的患者发生伤口感染、相关感染和再次手术的几率更高。需要更多研究合适的替代注射用杆菌肽的方法，以用于手术部位抗菌冲洗。
