Postoperative Antibiotics are Associated with Increased Complications following Fat Grafting for Breast Reconstruction
Kometh Thawanyarat, BA1; Thomas Johnstone, BS2; Mallory Rowley, BA3; Trudy Kim4; Shannon Francis, MSc2; Janos Barrera, MD5; Rahim Nazerali, MD, MHS, FACS5
1Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, Georgia, USA; 2Stanford University School of Medicine, Stanford, California, USA; 3State University of New York, Upstate Medical University, Syracuse, New York, USA; 4Stanford University, Vice Provost for Undergraduate Education, Stanford, California, USA; 5Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
Introduction: Autologous fat-grafting following breast reconstruction is commonly used to address asymmetry and irregularities in breast contour. While many studies optimize patient outcomes following fat-grafting, a potential factor is the optimal use of peri- and postoperative antibiotics. Studies show the use of prolonged prophylactic antibiotics do not lower the complication rates which stresses the need for a more conservative antibiotic protocol.
Methods: Patients in the Optum Clinformatics Data Mart who underwent all forms of breast reconstruction followed by fat-grafting were identified via CPT codes. Using a multivariable logistic regression and data concerning these patientís demographics, comorbidities, perioperative and postoperative antibiotics, and outcomes, the likelihood of any common postoperative complication was determined. All statistical assumptions were met successfully. Odds ratios and corresponding 95% confidence intervals were calculated.
Results: Across 86 million longitudinal patient records, the study extracted 3,926 patients who underwent fat-grafting between March 2004 and June 2019. Using a multivariate logistic-regression model, independent predictors of complications -- tobacco use, prior irradiation, and longer postoperative antibiotic regimens -- were determined. An extra day of postoperative antibiotics multiplies potential complications by a factor of 1.131; the odds are nearly 2.5 times higher for a patient undergoing a week-long postoperative antibiotic regimen than a patient receiving no treatment.
Conclusion: No single antibiotic type conferred a significant benefit to patient outcomes; increasing the duration of any postoperative antibiotic regimen conferred a significant increase in patient complications. This study provides national, claims-level support to adopt more conservative postoperative antibiotic prescription practices for breast reconstruction followed by fat-grafting.
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