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Decreasing Antibiotic And Surgical Site Infections In Reconstructive Breast Surgery: Results From A 2015 To 2022 National Evaluation
Joseph N. Fahmy, MD, MS, Jacob S. Nasser, MD, Hao Wu, MS, Lu Wang, PhD, Kevin C. Chung, MD, MS, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: The American Association of Plastic Surgeons recommends preoperative antibiotic prophylaxis for patients undergoing clean cosmetic breast surgery with or without implant. Beyond this recommendation, there are no guidelines regarding postoperative antibiotic use after reconstructive breast surgery. This study has two aims. First, to evaluate trends in antibiotic use after reconstructive breast surgery including implant-based reconstruction, tissue-based reconstruction, or breast reduction surgery. Second, to evaluate factors associated with surgical site infection in the postoperative period.
Methods: This analysis used a large national employer-sponsored insurance claims database (Meritive Marketscan) from 2015 to 2022. Patients were excluded if they had a preexisting infection that might require >48h oral antibiotics, such as gastroenteritis. Logistic regression was performed on variables or outcomes of interest which included: type of surgery, patient age, comorbidity burden, insurance type, or surgical site infection.
Results: A total of 39,374 patients were included. Over the study period, postoperative antibiotic use decreased by 69.3% (Figure 1). The use of antibiotics was associated with a 28% reduced odds of infection (95% CI, 0.64-0.81; p<0.001). Greater patient comorbidity burden was associated with a 13% increased odds of infection (Elixhauser 4-8, 95% CI: 0.82 to 0.93, p<0.001).
Conclusion: Though postoperative antibiotic use was associated with lower odds of postoperative breast infection, national antibiotic use is decreasing. Prophylactic postoperative antibiotic use >48h may benefit patients with greater medical comorbidities.
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