title: Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care.
abstract: BACKGROUND
  Despite their widespread use, there are no evidence-based guidelines on the management of closed-suction drains or antibiotics in postmastectomy breast reconstruction. The purpose of this study was to assess consensus and variation in postoperative care among plastic surgeons.
  
  
  METHODS
  The authors designed and administered a self-reported, anonymous survey to 4669 American Society of Plastic Surgeons and Canadian Society of Plastic Surgeons members in October 2009.
  
  
  RESULTS
  A total of 650 completed surveys were available for analysis. A majority (>81%) of respondents reported using closed-suction drains in breast reconstruction. Most surgeons (>93%) used a volume criteria for drain removal, most commonly when drain output was ≤30 mL over 24 hours (>86%). Preoperative antibiotic use was nearly universal (98%), usually consisting of intravenous cefazolin (97%). Postoperative care demonstrated less uniformity with outpatient antibiotics administered by 72% of respondents. Surgeons were divided on when to discontinue outpatient antibiotics: 46% preferred concomitant discontinuation with drains, whereas 52% preferred a specific postoperative day. No clear consensus was observed for the number (1 or 2) or type (Jackson-Pratt or Blake) of drains used. Respondents were further divided on the restriction of postoperative showering with drains and the use of acellular dermal matrix.
  
  
  CONCLUSIONS
  These results demonstrate a consensus for drain use, drain removal, and preoperative antibiotic administration. There was no consensus for number or type of drain used, postoperative antibiotic use, shower restrictions, and use of acellular dermal matrix. Our results further emphasize the need for evidence-based postoperative-care guidelines specific to breast reconstruction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. brett.phillips@stonybrook.edu
authors.forename: Brett T
authors.initials: BT
authors.lastname: Phillips
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wang
authors.forename: Joshua
authors.initials: J
authors.lastname: Mirrer
authors.forename: Steven T
authors.initials: ST
authors.lastname: Lanier
authors.forename: Sami U
authors.initials: SU
authors.lastname: Khan
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Dagum
authors.forename: Duc T
authors.initials: DT
authors.lastname: Bui
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000639:trends; D001291:Attitude of Health Personnel; D002170:Canada; D016009:Chi-Square Distribution; D004954:Esthetics; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012955:Societies, Medical; D013396:Suction / Q000295:instrumentation / Q000379:methods*; D013518:Surgery, Plastic / Q000592:standards* / Q000639:trends; D013530:Surgical Wound Infection / Q000517:prevention & control; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States