Evaluation of Extended Vs. Peri-operative Courses of Antibiotic Prophylaxis Following Immediate Implant-Based Breast Reconstruction
Casey Zhang, BA1; Elizabeth A. Moroni, MD MHA2; Samyd S. Bustos MD3; Arnab Ray, BA1; Carolyn De La Cruz, MD2; Michael L. Gimbel, MD2; Vu T. Nguyen, MD2.
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.2Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 3Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
Background: Immediate Implant-based Breast Reconstruction (IIBR) is the most commonly used method in breast reconstruction in the United States. However, post-operative Surgical Site Infections (SSI) can cause devastating reconstructive failure. This study evaluates the use of extended vs. peri-operative courses of antibiotic prophylaxis following IIBR for the prevention of post-operative SSI.
Methods: After obtaining IRB approval, we used a prospectively maintained institutional database of patients who underwent breast reconstruction at a single institution and identified patients who underwent IIBR between June 2018-April 2020. Detailed demographic and clinical information were collected. Statistical analyses were conducted using SPSSv24.0 with p≤0.05 considered statistically significant.
Results: A total of 169 patients (285 breasts) who underwent IIBR were included. Mean age was 52.4+/-10.2 years, and mean BMI was 26.8+/-5.7 kg/m2. Ninety-two percent (92.3%) identified themselves as White, 5.9% as African American, and 1.8% as Asian. Nine percent (9.0%) underwent post-mastectomy radiation therapy. A total of 59.9% patients received either chemotherapy or hormonal therapy. Twenty-five percent (25.6%) underwent nipple-sparing mastectomy, 69.1% skin-sparing mastectomy, and 5.3% total mastectomy. A total of 57.1% breasts had therapeutic mastectomy, 36.8% contralateral prophylactic mastectomy, and 7.0% full prophylactic mastectomy. Most underwent two-stage IIBR (87.4%), and 12.6% underwent one-stage IIBR. The implant was located in the pre-pectoral, sub-pectoral, and dual planes in 17.3%, 17.9%, and 64.8% cases, respectively. ADM was used in 78.7% of cases. A total of 58.0% received extended antibiotic prophylaxis (Group 1), and 42.0% received prophylaxis only up to 24h postoperatively (Group 2). Twenty-five infections were identified, of which nine resulted in reconstructive failure. In bivariate analyses, no difference was found between groups in rates of infection (p=0.273), reconstructive failure (p=0.653), and seroma (p=0.125). There was a difference in hematoma rates between groups (p=0.046). Interestingly, when comparing only patients with BMI≥25 between the two groups, Group 2 (n=43) had a higher infection rate (25.6%) than Group 1 (n=55, 16.4%) (p=0.049).
Conclusions: Our data demonstrate no statistical difference in infection rates between extended and peri-operative antibiotic regimens. This suggests that the efficacies of current prophylaxis regimens are largely similar, with choice of regimen based on surgeon preference and patient-specific considerations. Infection rates in overweight patients who received only peri-operative prophylaxis were significantly higher, suggesting BMI should be taken into consideration when choosing a prophylaxis regimen. This may also have implications on timing of staged reconstruction to optimize patient BMI prior to implant exchange to minimize risk of SSI.
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