The use of prophylactic antibiotics in plastic surgery clean and clean contaminated outpatient cases has not been reviewed recently in the literature. The use of antibiotics account for billions of dollars in spending yearly in health care and the Affordable Care Act has recently named prophylactic antibiotic use as a general marker of physician quality. This study was designed to 1) investigate whether or not antibiotics were being administered within Center for Disease Control’s (CDC) guidelines preoperatively, 2) the amount of patients receiving postoperative antibiotics, 3) if there was a significant difference in the outcome of the surgery when postoperative antibiotics were given compared to when they were not, and 4) to see if there were any underlying co-morbidies that significantly impacted the outcome of the procedure.
Methods/Technique:
An IRB-approved retrospective chart review identified 1800 patients undergoing plastic surgery procedures from January 2008 to January 2012. The cohort studied was isolated using the location of the surgery, the university’s outpatient building, with the goal of assessing complications in a wide range of plastic and reconstructive surgery cases. A total of 468 patients were identified using our database. Preoperative antibiotic administration times were compared to the start time of surgery and groups were created comparing patients who received postoperative antibiotics and those who did not. Variables were collected for each patient encounter, some of which include co-morbidities prior to surgery (tobacco use, diabetes, DVT risk, etc.), as well as the occurrence of wound complications noted in follow up visits. Wound complications were defined as one or more of the following: infection, dehiscence, erythema, necrosis, seroma, hematoma, and delayed wound healing. Cases with insufficient follow up data (<30 days) were excluded from our database, with the majority followed for complications as long as the medical record would allow.
Results/Complications:
The results from this study found that 100% of patients received preoperative antibiotics but only 19.87% received them one hour or more prior to the initial incision as the CDC suggests. However, 46.37% of patients received the antibiotics 15 to 44 minutes prior to surgery. Sixty-eight percent of patients received postoperative prophylactic antibiotics. When compared to the thirty two percent who did not, there were no significant differences in complication rates when analyzed using multivariate analysis. There were also no co-morbidities that had a significant effect on whether or not the patient had a complication after surgery.
Conclusion:
This data shows that if the patient receives preoperative antibiotics there is no need to prescribe antibiotics postoperatively. This has the potential to save millions of dollars yearly on antibiotics and can potentially reduce the instances of antibiotic resistant bacteria.