Do Extended Prophylactic Antibiotics Really Protect Against Infection and Implant Loss in High-Risk Tissue Expander Breast Reconstruction?
Kaitlin Monroig, BA1, Kailash Kapadia, MD2, Jocellie E. Marquez, MD, MBA3, Hunter Rogoff, BS1, Alexandra Snock, BA1, Jared Hinson, BS1, William Marmor, BS1, Kanad Ghosh, BA1, Christopher Medrano, BA1, Phoebe McAuliffe, BA1, Tara L. Huston, MD, FACS4, Jason Ganz, MD4, Alexander B. Dagum, MD4, Sami Khan, MD, FACS4, Duc Bui, MD4.
1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA, 3Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA, 4Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA.
Background:Antibiotic prophylaxis after tissue expander-breast reconstruction (TEBR) is a highly debated topic, yet, few studies have explored whether longer courses of prophylactic antibiotics mitigate complications in high-risk groups. The purpose of this study is to determine whether an extended prophylactic antibiotic regimen protects against surgical site infection (SSI) and implant loss in high-risk patients.Methods: A retrospective review of immediate TEBRs (2001-2018) at a single institution was performed. Demographics, comorbidities, pre and postoperative chemotherapy/radiation, use of ADM and complications were compared. High-risk patients were defined as patients with BMI ≥ 30 kg/m2, current or former tobacco use, diabetes, or preoperative chemotherapy/radiation. SSIs diagnosed prior to stage 2 were included. Implant loss was defined as removal of the tissue expander due to clinical signs of infection without immediate replacement.Results: Of 672 TEBRs, 330 high-risk patients were analyzed. 122 patients received 24-hour perioperative antibiotics only (Group 1). 208 patients received 24-hour perioperative and discharge oral antibiotics (Group 2). The mean BMI was 29.0 and 29.7 kg/m2 in groups 1 and 2 respectively (p=0.324). The mean age in both groups was 53 years. Previous irradiation was documented in 7.3% and 13.9% of groups 1 and 2 (p=0.677), respectively.There were no differences in hypertension (p=0.71), hyperlipidemia (p=0.071) or ADM usage (p=0.677). Although there were significant differences in comorbidities such as use of tobacco (63.9% vs 50.9%, p=0.022), alcohol use (61.5% vs 49.5%, p=0.035), diabetes (4.9% vs 17.3%, p=0.0011), and preoperative chemotherapy (18.0% vs 31.7%, p=0.0066), further logistic regression determined these variables were not independent predictors of SSI or implant loss related to infection. Overall SSI in this high-risk cohort was 27%. Group 1 presented with signs of infection sooner (40.9 days vs. 61.4 days, p=0.066) than group 2, which approached statistical significance. Despite this trend, there were no significant differences in SSI (23.8% vs 28.8%, p=0.316), implant loss (12.3% vs 15.9%, p=0.375), or reconstruction failure (9.0% vs 13.5%, p=0.423) rates between groups 1 and 2, respectively.Conclusion: Extended prophylactic antibiotic regimens do not provide additional protection against development of SSI, implant loss due to infection, or reconstruction failure in TEBR high-risk patients. In fact, trends suggest it delays clinical manifestation of an SSI. This study contributes to the growing literature supporting judicious prophylactic antibiotic use in breast reconstruction.
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