by Ranganathan, Kavitha; Sears, Erika D.; Zhong, Lin;
Chung, Ting-Ting; Chung, Kevin C.; Kozlow, Jeffrey H.; Momoh, Adeyiza O.;
Waljee, Jennifer F.
Background:
Numerous techniques are used to prevent infection after immediate implant-based
breast reconstruction. Postoperative antibiotic prophylaxis is commonly
prescribed to decrease the risk of reconstructive failure, despite conflicting
evidence regarding its effectiveness. The authors studied whether postoperative
antibiotic prophylaxis decreases the risk of infection-related explantation in
the setting of immediate prosthesis-based breast reconstruction. Methods: Using
Truven MarketScan databases, the authors identified all patients who underwent
immediate implant reconstruction between January of 2010 and June of 2014 with
at least 6 months of follow-up. Postoperative antibiotic prophylaxis was
defined as any oral antibiotic course to be taken postoperatively based on
prescriptions filled within 14 days preoperatively through 24 hours after
discharge. Reconstructive failure, defined as explantation because of
infection, was the primary outcome. Secondary outcomes of interest included
wound complications, infection, and readmission for infection. Multivariable
regression analyses controlled for demographic variables/comorbidities.
Results: Of the 7443 patients, 6049 (81 percent) filled prescriptions for
postoperative antibiotic prophylaxis. These patients were equally likely to
develop a wound complication (OR, 0.93; 95 percent CI, 0.71 to 1.23) or
infection (OR, 0.89; 95 percent CI, 0.70 to 1.14), undergo explantation because
of infection (OR, 0.82; 95 percent CI, 0.57 to 1.18), or require readmission
for infection (OR, 1.21; 95 percent CI, 0.82 to 1.78) compared with those who
did not receive antibiotics. There was no significant difference in the risk of
infection-related outcomes based on postoperative antibiotic prophylaxis
duration. Conclusions: Postoperative antibiotic prophylaxis was not associated
with a reduced risk of infection or explantation following prosthesis-based
breast reconstruction. Given rising rates of antibiotic resistance, focusing
instead on technical considerations and the management of comorbid conditions
may more effectively enhance the safety of breast reconstruction. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
