Plastic surgeons commonly place patients undergoing sterile/clean skin-only procedures requiring closed suction drains (CSD) on post-operative prophylactic antibiotic therapy for prolonged courses (>24 hours). The myth that patients who have CSD must receive prolonged antibiotics is perpetuated in medical institutions. This is an area in plastic surgery where experience-based medicine is challenged by evidence.
Methods/Technique:
Systematic literature review was performed using Medline, Embase, Pubmed and Cochrane databases to identify all studies evaluating employing prophylactic antibiotics after patients had CSD placed. Final search was conducted in October 2011. Mesh search terms included: “drain(s),” “closed suction,” “prophylaxis,” “infection,” and “antibiotics." The combination of search terms generated pertinent articles. Three reviewers independently evaluated the studies for inclusion (criteria—level 1 and 2 studies and large retrospective reviews) or exclusion (criteria—case reports).
An IRB approved survey was disseminated to all ASPS members. E-survey link was distributed via email to ASPS members inviting them to participate. Responses/data were collected over a 5-month period through SurveyMonkey.
Results/Complications:
515 articles published before October 2011 were identified. 92 articles remained after eliminating duplicates and applying inclusion criteria. After employing exclusion criteria, nine articles remained. There was 100% agreement between the three reviewers.
5299 questionnaires were disseminated and 687 (13%) plastic surgeons responded. 52.3% of respondents employ post-operative antibiotics (>24 hours) for patients who have elective, sterile/clean procedure requiring placement of CSD. 27.7%, 29.4%, 42.3%, and 0.6% kept patients on antibiotics for the following durations: up to 3 days, one week, as long as drains are in, >1 week, respectively.
Conclusion:
Critical literature review validated no evidence supporting placing patients on prolonged antibiotic courses during clean/sterile procedures when CSD are employed. Evidence based medicine elucidates correct clinical scenarios where there is need for antibiotics. The survey provides data on variable practice patterns of plastic surgeons based on their experiences.