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The True Impact Of Penicillin Allergies On Implant-Based Breast Surgery: A Multi-Institutional Retrospective Analysis
Sharbel A. Elhage, MD, Theodore E. Habarth-Morales, BS, Malia Voytik, MD, Salman Kahn, BS, Margaret M. Hornick, MD, Joseph M. Serletti, MD, John P. Fischer, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE:Penicillin allergy (PCA) limits first-line antibiotic use despite low cross-reactivity with first-generation cephalosporins (FGC), leading to potentially higher infection rates in patients with PCA. We aimed to assess PCA's effects on breast implant-based patients, hypothesizing that PCA increases implant infection risk due to alternative antibiotic choices.
METHODS:TriNetX LLC (Cambridge, MA) National Health Research Network was queried for patients undergoing breast tissue expander (TEX) or implant placement for reconstruction or cosmetic surgery between July 2016 and July 2024. Primary outcomes were the choice of preoperative antibiotic and the presence of infection within 90 days of surgery. A propensity-scored match was performed to control for various patient characteristics and comorbidities.
RESULTS:A total of 57,157 patients met the inclusion criteria, and 2,844 had PCA. PCA patients were older and had higher rates of breast cancer, obesity, diabetes mellitus, and smoking history (all p<0.001). PCA patients were less likely to receive FGC prophylaxis (55.3%vs88.7%, p<0.001) and had higher rates of postoperative infection (14.0%vs8.1%, p<0.001) and unplanned implant removal (10.4%vs7.2%, p=0.01). Propensity matching yielded 2,844 matched pairs. Findings remained similar with decreased use of FGC (56.6%vs87.0%, p<0.001), and with increased rates of implant or TEX infection (9.8%vs7.3%, p=0.001) and unplanned removal (5.9%vs4.7%, p=0.041). Anaphylaxis rates regardless of antibiotic used were similar.
CONCLUSION:PCA strongly influences preoperative antibiotic choice and leads to increased rates of postoperative breast prosthesis infection and unplanned removal. Further work is needed to safely improve adherence to preoperative antibiotic guidelines in patients with PCA.
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