title: The role of hydroxyethyl starch in preventing surgical-site infections and nipple necrosis in patients undergoing reduction mammaplasty: a prospective case-control study of 334 patients.
abstract: BACKGROUND
  Surgical-site infections after reduction mammaplasty are associated with poor cosmetic results. This study investigated the postoperative antiinflammatory influence of hydroxyethyl starch and its effect on surgical-site infections after breast reduction.
  
  
  METHODS
  In this prospective case-control study, 334 patients undergoing reduction mammaplasty were prospectively assigned in a 2:1 ratio to receive either 2 × 250 ml of hydroxyethyl starch 6 % or saline solution 0.9 % for 3 days postoperatively. Patient follow-up evaluation was at least 1 month. Using uni- and multivariate analyses, this study aimed to identify risk factors for surgical-site infections and nipple necrosis.
  
  
  RESULTS
  Surgical-site infections occurred in 6.6 % of the hydroxyethyl starch group and in 3.6 % of the control group (p = 0.704). Hydroxyethyl starch had no effect of reducing surgical-site infections [p = 0.212; odds ratio (OR), 0.317; confidence interval (CI), 0.052-1.925]. According to univariate analyses, hydroxyethyl starch reduced the occurrence of postoperative fever (p = 0.085; OR 0.608; CI 0.345-1.072), and fever was associated with increased infection rates (p = 0.033; OR 2.335; CI 1.071-5.089). Additional risk factors for postoperative infections were diabetes (p = 0.051; OR 4.051; CI 0.997-16.463) and obesity (normal weight vs grade ≥2: p = 0.003; OR 7.612; CI 2.031-28.529). Multivariate analysis showed no independent predictors for surgical-site infections. Nipple necrosis were equally observed in the two groups (p = 0.458; OR 1.643; CI 0.443-6.097).
  
  
  CONCLUSIONS
  The antiinflammatory approach of hydroxyethyl starch did not lead to a decrease in infections or nipple necrosis. No difference in surgical-site infections was observed between aesthetic and oncologic procedures.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059, Rostock, Germany. max.dieterich@uni-rostock.de
authors.forename: Max
authors.initials: M
authors.lastname: Dieterich
authors.forename: Toralf
authors.initials: T
authors.lastname: Reimer
authors.forename: Guenther
authors.initials: G
authors.lastname: Kundt
authors.forename: Johannes
authors.initials: J
authors.lastname: Stubert
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D016462:Mammaplasty; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D009558:Nipples / Q000473:pathology*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012965:Sodium Chloride