Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial

Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial

BACKGROUND:Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on...

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Bibliographic Details
Published in:Plastic and reconstructive surgery (1963) Vol. 145; no. 6; pp. 1022e - 1028e
Main Authors: Garcia, Edgard S., Veiga, Daniela F., Veiga-Filho, Joel, Cabral, Isaías V., Pinto, Natália L. L., Novo, Neil F., Sabino-Neto, Miguel, Ferreira, Lydia M.
Format: Journal Article
Language:English
Published: United States by the American Society of Plastic Surgeons 01-06-2020
American Society of Plastic Surgeons
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis - methods
Breast - abnormalities
Breast - surgery
Cephalothin - therapeutic use
Female
Follow-Up Studies
Humans
Hypertrophy - surgery
Incidence
Mammaplasty - adverse effects
Postoperative Care - methods
Surgical Wound Infection - epidemiology
Surgical Wound Infection - etiology
Surgical Wound Infection - prevention & control
Treatment Outcome
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Summary:BACKGROUND:Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty. METHODS:The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted. RESULTS:There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003). CONCLUSION:The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, I.
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ISSN:0032-1052
1529-4242
DOI:10.1097/PRS.0000000000006809