From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University.
Calc LLC.
Plast Reconstr Surg. 2024 Mar 1;153(3):496e-504e. doi: 10.1097/PRS.0000000000010825. Epub 2023 Jun 19.
Conflicting evidence exists regarding the utility of prophylactic postoperative antibiotics in tissue expander (TE)-based breast reconstruction. This study evaluated the risk of surgical-site infection between patients receiving 24 hours of perioperative antibiotics alone versus prolonged postoperative antibiotics within a propensity score-matched cohort.
Patients undergoing TE-based breast reconstruction receiving 24 hours of perioperative antibiotics alone were propensity score-matched 1:3 to patients receiving postoperative antibiotics based on demographics, comorbidities, and treatment factors. Incidence of surgical-site infection was compared based on duration of antibiotic prophylaxis.
Of a total of 431 patients undergoing TE-based breast reconstruction, postoperative antibiotics were prescribed in 77.2%. Within this cohort, 348 were included for propensity matching (no antibiotics, 87 patients; antibiotics, 261 patients). After propensity score matching, there was no significant difference in incidence of infection requiring intravenous (no antibiotics, 6.9%; antibiotics, 4.6%; P = 0.35) or oral antibiotics (no antibiotics, 11.5%; antibiotics, 16.1%; P = 0.16). In addition, rates of unplanned reoperation ( P = 0.88) and 30-day readmission ( P = 0.19) were similar. After multivariate adjustment, prescription of postoperative antibiotics was not associated with a reduction in surgical-site infection (OR, 0.5; 95% CI, -0.3 to 1.3; P = 0.23).
Within a propensity score-matched cohort accounting for patient comorbidities and receipt of adjuvant therapies, prescription of postoperative antibiotics after TE-based breast reconstruction conferred no improvement in rates of TE infection, reoperation, or unplanned health care use. These data underscore the need for multicenter randomized trials on the utility of antibiotic prophylaxis in TE-based breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在基于组织扩张器（TE）的乳房重建中，预防性术后抗生素的效用存在相互矛盾的证据。本研究评估了接受 24 小时围手术期抗生素治疗的患者与接受延长术后抗生素治疗的患者在倾向评分匹配队列中的手术部位感染风险。
接受单独 24 小时围手术期抗生素治疗的基于 TE 的乳房重建患者，根据人口统计学、合并症和治疗因素，按倾向评分匹配 1:3 至接受术后抗生素治疗的患者。根据抗生素预防的持续时间比较手术部位感染的发生率。
在总共 431 例接受基于 TE 的乳房重建的患者中，有 77.2%的患者开具了术后抗生素。在该队列中，348 例患者进行了倾向评分匹配（无抗生素组，87 例；抗生素组，261 例）。在倾向评分匹配后，需要静脉（无抗生素组，6.9%；抗生素组，4.6%；P=0.35）或口服抗生素（无抗生素组，11.5%；抗生素组，16.1%；P=0.16）的感染发生率无显著差异。此外，计划外再次手术的发生率（P=0.88）和 30 天再入院率（P=0.19）相似。在多变量调整后，术后抗生素的处方与手术部位感染的减少无关（比值比，0.5；95%置信区间，0.3 至 1.3；P=0.23）。
在考虑患者合并症和接受辅助治疗的倾向评分匹配队列中，基于 TE 的乳房重建后开具术后抗生素并不能提高 TE 感染、再次手术或计划外医疗使用的发生率。这些数据强调了在基于 TE 的乳房重建中抗生素预防效用方面进行多中心随机试验的必要性。
临床问题/证据水平：治疗性，III 级。
