title: Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction.
abstract: BACKGROUND
  Although some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction.
  
  
  METHODS
  The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using χ² and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders.
  
  
  RESULTS
  A total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling.
  
  
  CONCLUSIONS
  We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago; †American Society of Plastic Surgeons, Arlington Heights, IL; ‡Department of Plastic Surgery, The Ohio State University, Columbus, OH; §Kentucky Aesthetics & Plastic Surgery Institute, Louisville, KY; ∥Division of Breast Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL; ¶Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, PA; and #Northwestern Specialists in Plastic Surgery, Chicago, IL.
authors.forename: Kerry E
authors.initials: KE
authors.lastname: Drury
authors.forename: Steven T
authors.initials: ST
authors.lastname: Lanier
authors.forename: Nima
authors.initials: N
authors.lastname: Khavanin
authors.forename: Keith M
authors.initials: KM
authors.lastname: Hume
authors.forename: Karol A
authors.initials: KA
authors.lastname: Gutowski
authors.forename: Brian P
authors.initials: BP
authors.lastname: Thornton
authors.forename: Nora M
authors.initials: NM
authors.lastname: Hansen
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
authors.forename: Neil A
authors.initials: NA
authors.lastname: Fine
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents