Department of Plastic Surgery, Medical School, University of Ioannina, Leoforos St. Niarchou, 45500, Ioannina, Greece.
Aesthetic Plast Surg. 2023 Jun;47(3):1009-1017. doi: 10.1007/s00266-023-03313-2. Epub 2023 Mar 16.
Mounting evidence suggests that breast reduction surgery displays higher rates of surgical site infections (SSI) than initially presumed. Objective of this network meta-analysis is to evaluate the effectiveness of different antibiotic regimens in the prophylaxis from surgical site infections and delayed wound healing (DWH) following breast reduction.
A network meta-analysis was conducted using a predetermined protocol after searching the electronic databases MEDLINE, Scopus, the Cochrane Library and US National Institutes of Health Ongoing Trials Register from inception to July 2022. The included studies had to examine breast reduction in females with at least 1-month follow-up, receiving antibiotics in an intervention arm compared to a control arm. The quality of studies was assessed using the Cochrane risk of bias tool. A frequentist Mantel-Haenszel approach was adopted for the reported SSI rates while an inverse variance random effects model was used for the DWH rates.
A total of 10 studies was included in the analysis involving 1331 patients. All but one study controlled for major risk factors, and no differences were observed in patients' baseline characteristics. Antibiotic administration significantly reduced the SSI rate after breast reduction, with the prolonged antibiotic regimen being the most efficacious (odds ratio [OR]: 0.36 [95%CI: 0.15-0.85]). No statistically significant reduction in delayed wound healing rate was revealed among the regimens.
Antibiotics mitigate the SSI rate after breast reduction. This meta-analysis provides an evidence-based strategy to optimize antibiotic administration. Further research is needed though to examine antibiotic prophylaxis on delayed wound healing.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
越来越多的证据表明，乳房缩小手术后的手术部位感染（SSI）发生率高于最初的预期。本网络荟萃分析的目的是评估不同抗生素方案在预防乳房缩小术后手术部位感染和延迟伤口愈合（DWH）方面的有效性。
使用预先确定的方案进行网络荟萃分析，在 2022 年 7 月之前，通过搜索电子数据库 MEDLINE、Scopus、Cochrane 图书馆和美国国立卫生研究院正在进行的试验登记处进行检索。纳入的研究必须检查女性乳房缩小术，至少有 1 个月的随访期，干预组与对照组相比接受抗生素治疗。使用 Cochrane 偏倚风险工具评估研究质量。采用固定效应 Mantel-Haenszel 方法报告 SSI 发生率，采用逆方差随机效应模型报告 DWH 发生率。
共纳入 10 项研究，涉及 1331 名患者。除一项研究外，所有研究均控制了主要危险因素，患者的基线特征无差异。抗生素给药显著降低了乳房缩小术后的 SSI 发生率，延长抗生素方案的效果最显著（比值比[OR]：0.36[95%CI：0.15-0.85]）。在不同方案中，延迟伤口愈合率无统计学显著降低。
抗生素可降低乳房缩小术后的 SSI 发生率。本荟萃分析为优化抗生素管理提供了循证策略。不过，仍需要进一步研究抗生素预防延迟伤口愈合的效果。
证据水平 III：本期刊要求作者为每篇文章指定一个证据级别。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
