Clare Richardson, Gennaya Mattison, James Roring, Adrienne Workman, Subhas Gupta
Antibiotic prophylaxis administered perioperatively has been shown to decrease the risk for the core measure of post-operative surgical site infection, but specifics of use vary widely among different surgical specialties. This study aimed to perform a meta-analysis of the current literature to determine the optimal duration of antibiotic prophylaxis in the field of plastic surgery.
A systematic literature review was conducted using various terms to locate studies of prophylactic antibiotic use in the field of plastic surgery within the US National Library of Medicine (PubMed). Studies included in the analysis were those with clearly recorded antibiotic dosage, duration and incidence of surgical site infection. Studies were excluded if they included non-plastic surgery procedures or if they did not clearly meet our study parameters. 32 studies were identified. 12 of them involved head and neck surgery, 12 of them involved breast and body surgery, 7 of them involved hand surgery and 1 included multiple types of plastic surgery procedures. The data from each study was divided into one of four duration categories: no antibiotic prophylaxis, single-dose prophylaxis, 24-hour prophylaxis or extended course (24 hr+) prophylaxis. The data was then statistically analyzed for each duration group.
A Forest plot of each of the four categories was created and analyzed using the random effect model. The average percent of events per population for each category was as follows: no prophylaxis was 14.7%, a single dose prophylaxis was 7.7%, 24 hours prophylaxis was 14.1% and extended course of antibiotics was 8.8%. The confidence intervals for each of the four categories overlapped in the combined Forest plot. A comparison of the data for antibiotic prophylaxis demonstrates a possible decrease in post-operative incidents for the single dose prophylaxis and the extended course of antibiotics in comparison to no antibiotics and a 24-hour course of antibiotics. However, as the confidence intervals are wide and overlapping, these findings are not statistically significant. At this time, more research is needed to reach a better understanding of the optimum duration of antibiotic prophylaxis following plastic surgery procedures.
