title: A single-center retrospective review of postoperative infectious complications in the surgical management of mandibular fractures: Postoperative antibiotics add no benefit.
abstract: Mandibular fractures are common facial injuries and treatment may be complicated by post-operative infection. Risk of infection from contamination with oral flora is well established but no consensus exists regarding antibiotic prophylaxis. The purpose of this study is to assess risk factors and perioperative antibiotics on surgical site infection (SSI) rates following mandibular fracture surgery.
  
  
  
  Retrospective medical record review was completed for trauma patients of any age surgically treated for mandibular fractures at a Level I Trauma Center from September 2006 to June 2012. Outcomes analysis was performed to determine SSI rates related to perioperative antibiotic use and other risk factors that may contribute to SSI.
  
  
  
  359 patients met inclusion criteria for analysis. 76% were male. Mean age was 30.5 years. Thirty-eight patients developed SSI (10.6%). SSI rate was lower in closed versus open surgery (3.2% vs. 16.3%, p=0.0001), and in closed versus open fractures (1% vs. 14%, p=0.0005). SSI rate increased in patients with tobacco, alcohol, and drug use (14.6%, 13.2%, 53.6%, p<0.0001), traumatic dental injuries (19.6%, p=0.0110), and patients in motor vehicle crashes (12.2%, p=0.0062). SSI rates stratified by Injury Severity Score (ISS) less than or equal to 16 (23/255 [9%]) versus ISS greater than 16 (15/104 [14%]) trended toward more severely injured patients developing SSI, p=0.1347. SSI rate was similar in patients who did and did not receive post-operative antibiotics (14.7% vs. 9.6%, p=0.2556). Type of antibiotic, duration of post-operative antibiotic administration, and duration between injury and surgery did not effect SSI rate.
  
  
  
  Findings suggest that following surgical treatment of mandible fractures, open surgery, open fractures, and risk factors including substance abuse, traumatic dental injury, and mechanism of injury significantly increase SSI rates, while post-operative antibiotics do not appear to provide additional benefit compared to pre-operative antibiotics alone.
  
  
  
  Therapeutic study, level IV.
authors.affiliation: From the Department of General Surgery (F.D.), University of Tennessee College of Medicine, Chattanooga, Tennessee; Department of Plastic and Reconstructive Surgery (E.D.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Mathematics (C.G.), University of Tennessee at Chattanooga, Chattanooga, TN; University of Tennessee College of Medicine (C.G., Medical Student), Memphis, Tennessee, Department of Surgery (J.D.S.), University of Tennessee College of Medicine, Chattanooga, Tennessee, Department of Surgery (R.A.M.), University of Tennessee College of Medicine, Chattanooga, Tennessee, and Department of Plastic and Reconstructive Surgery (J.L.W.), University of Tennessee College of Medicine, Chattanooga, Tennessee.
authors.forename: Fernando
authors.initials: F
authors.lastname: Domingo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dale
authors.forename: Cuilan
authors.initials: C
authors.lastname: Gao
authors.forename: Cynthia
authors.initials: C
authors.lastname: Groves
authors.forename: Daniel
authors.initials: D
authors.lastname: Stanley
authors.forename: Robert A
authors.initials: RA
authors.lastname: Maxwell
authors.forename: Jimmy L
authors.initials: JL
authors.lastname: Waldrop
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008337:Mandibular Fractures / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents