Attitudes and Practices of Plastic Surgeons Regarding Antibiotic Prophylaxis and Postoperative Care Patterns in Immediate Breast Reconstruction
Jocellie Marquez, MD, MBA1, Brett Phillips, MD, MBA2, Christopher Jou, MD3, Annet Kuruvilla, BS4, Sourish Ratha, BE5, Gabriel Klein, MD1, MS, Gurtej Singh, PhD1, Tara L. Huston, MD, FACS1, Alexander Dagum, MD, FACS1, Sami Khan, MD, FACS1, Duc Bui, MD1
1Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital, Stony Brook, NY, 2Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 3Department of Plastic Surgery, The Cleveland Clinic, Cleveland, OH, 4Stony Brook University School of Medicine, Stony Brook, NY, 5 New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, NY
Introduction: Extended prophylactic antibiotics after immediate implant breast reconstruction (I-IBR) remains common practice for plastic surgeons. In 2016, our group published a randomized clinical trial (RCT) demonstrating no significant difference between short (60% reported over 15 years experience. Drains were used in nearly every I-IBR and >70% used ADM in >75% of I-IBRs. ADM did not influence usual antibiotic and drain protocol in 94.7% and 85.6%, respectively. Preoperative antibiotics in I-IBR nearly reached consensus (97%) with cefazolin (89.6%) as the most common; clindamycin (65.4%) was most common penicillin-allergic alternative. Regarding changes in prophylactic antibiotic usage over the past 5 years, 81% reported no change. Majority of participants currently use extended outpatient antibiotics prophylaxis with Keflex (52%). Extended antibiotics were most likely to be discontinued with drain removal (60%) or specific postoperative day (21%) of which days 6-10 (48.6%) were preferred. Only ~17% surgeons reported the short prophylactic antibiotics as their current protocol. About 46.3% reported awareness of a RCT that examined the duration of perioperative prophylactic antibiotics in I-IBR. Interestingly, ~50% reported that if a study existed that demonstrated no difference in outcomes between short and extended prophylactic antibiotic regimens, they would consider adjusting their practice to a shorter prophylactic protocol. On the other hand, 33.7% remained firm that they would not change from prescribing extended prophylactic antibiotics despite research evidence demonstrating no additional benefit.
Conclusion: There remains no consensus among plastic surgeons regarding the duration of prophylactic antibiotics after I-IBR despite the presence of Level 1 evidence. Only half of surgeons were aware that data existed while one-third remained reluctant to change to the short regimen regardless of the literature. Further research is needed to identify the factors that would help increase awareness and improve implementation of evidence-based medicine.
Back to 2021 Abstracts