The Effect of Antibiotic and Drain Duration on Infectious Complications Following Alloplastic Breast Reconstruction
Gabriel Klein, M.D., Lily Wang, B.S., Brett Phillips, M.D., MBA, Sami Khan, M.D., Alexander Dagum, M.D., Duc Bui, M.D..
Stony Brook University Hospital, Stony Brook, NY, USA.
PURPOSE: There is currently no evidence based standard for postoperative antibiotic or drain duration following alloplastic breast reconstructions. In this study we investigate infectious outcomes following alloplastic breast reconstruction in two different antibiotic duration groups.
METHODS: This retrospective cohort study investigated all patients undergoing alloplastic breast reconstruction at a single institution from 2010-2012. During this period some patients were enrolled in a trial where antibiotics were discontinued after 24 hours. All other patients had antibiotics continued until drain removal. Both study and non-study patients from the time period were included and compared by antibiotic and drain duration, comorbidities, demographics, and infectious complications. Statistical analysis was performed via Generalized Linear Mixed Model.
RESULTS: Our cohort included 282 patients with 467 reconstructions. There was no significant difference in demographics and comorbidities amongst antibiotic groups. The rates of cellulitis and deep space infection in both study groups was 10.7%. No significant difference was found in cellulitis rates between the antibiotic groups (p=0.713), although patients in the 24 hour antibiotic use were found to have lower rates of deep space infection (OR= 0.329, p=0.0386). Prolonged drain duration (>2 weeks) was associated with both cellulitis and deep space infection rate (p=0.0015 and 0.0007 respectively) while having no significant effect on seroma occurrence (p=0.1269).
CONCLUSION: These results show that drain duration longer than 2 weeks may contribute to postoperative infections while having no effect on seroma occurrence. Prolonging the course of antibiotics does not appear to reduce infectious complications, although further randomized prospective trials are needed.
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