Optimal Post- Operative Antibiotic Prophylaxis after Breast Surgery: a Meta- Analysis
Charalampos Siotos, Mohamad E. Sebai, MBBS, Stella M. Seal, MLS, Mehran Habibi, MD, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
BACKGROUND:Current clinical guidelines dictate the use of prophylactic antibiotics antibiotic after breast surgery for the prevention of surgical site infections (SSI). However, there is no agreement among physicians whether post-operative prophylaxis after clean surgeries, like breast surgery is necessary nor for the duration of the prophylaxis. We sought to evaluate systematically the current literature regarding the optimal use and duration of post-operative antibiotic prophylaxis in plastic breast surgery.
METHODS:We systematically searched the PubMed, Embase, Cochrane and Web of Science databases for relevant articles published until January, 2017. We performed meta-analysis employing Random Effects Model and the RevMan software.
RESULTS:Our search revealed 727 articles, which were screened based on their title and abstract. Of them 56 were screened based on the full text. Following the screening process, 10 studies (one randomized trial, one observational prospective and eight retrospective) met our criteria. Overall, 4,354 patients were included that undergone mastectomy, breast reconstruction, breast reduction or breast augmentation. Meta-analysis of 6 studies showed that pre-operative only use of antibiotics was associated with higher risk for SSI, although not at a statistically significant level (2,902 patients, OR=1.54, 95%CI [0.87-2.74], p=0.31, I2=64%, Figure 1). The results of our second meta-analysis indicate that short duration (≤24 hours) of post-operative antibiotics was statistically significantly associated with higher odds of SSI (5 studies, 2,843 patients, OR=1.59, 95%CI [1.02-2.46], p=0.04, I2=28%, Figure 2). Flap necrosis did not differ among the two patients group receiving antibiotics for longer or shorter duration (2 studies, 1,148 patients, OR=1.03, 95%CI [0.72-1.47], p=0.87).
CONCLUSIONS:According to the results of our meta-analyses, prolonged (>24 hours) duration of prophylactic antibiotics after breast surgery is necessary to prevent surgical site infections. However, limited data are currently available. Further prospective studies are necessary to establish the optimal duration of post-operative prophylactic antibiotics, balancing the benefit of infections prevention and the risk of related complications and cost. 
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