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Prophylactic antibiotics in head and neck free flap surgery: A novel protocol put to the test
Sanjeev M Balamohan1, Raja Sawhney1, Dustin M Lang1
1Department of Otolaryngology, University of Florida, Gainesville, FL, USA.
Objective:
Recent evidence supports the use of ampicillin-sulbactam as a favored choice for antibiotic prophylaxis following head and neck free flap reconstructive surgery. However, there is a paucity of evidence guiding the optimal duration of antibiotic prophylaxis. The aim of this study is to compare the infection rates of short courses of ampicillin-sulbactam versus extended courses of various antibiotics in head and neck free flap reconstructive surgery.
Methods:
This is a retrospective cohort study conducted from 2012 to 2017 at a tertiary academic center on 266 consecutive patients undergoing head and neck surgery with free flap reconstruction. The primary outcome measure was the rate of any infection within 30 days of surgery.
Results:
There were 149 patients who received antibiotic prophylaxis for an extended duration of at least seven days. 117 patients received a short course of antibiotics defined as 24 h for non-radiated patients and 72 h for radiated patients. Postoperative infections occurred in 45.9% of patients, of which 92.6% occurred at surgical sites. There was no significant difference in terms of postoperative infection rate between patients receiving an extended duration of antibiotics versus a short duration (p = 0.80). This held true for subgroups of surgical site infections (p = 0.38) and distant infections (p = 0.59 for pneumonia and p = 0.76 for UTI). Risk factors for infections were identified as hypothyroidism (p = 0.047) and clean contaminated wound classification (p = 0.0002).
Conclusion:
Shorter duration of ampicillin-sulbactam prophylaxis in free flap reconstruction of head and neck defects does not negatively affect postoperative infection rates.
Level Of Evidence:
Level 2b.
Insights
Shorter antibiotic prophylaxis durations for head and neck free flap surgery do not increase infection rates. This study found no significant difference in postoperative infections between short and extended antibiotic courses.
Area of Science:
- Reconstructive Surgery
- Infectious Disease
- Surgical Oncology
Background:
- Ampicillin-sulbactam is a common choice for antibiotic prophylaxis in head and neck free flap surgery.
- Optimal duration of antibiotic prophylaxis remains unclear, necessitating further investigation.
Purpose of the Study:
- To compare postoperative infection rates between short-course and extended-course antibiotic prophylaxis in head and neck free flap reconstructive surgery.
- To evaluate the impact of antibiotic prophylaxis duration on infection rates in this patient population.
Main Methods:
- Retrospective cohort study of 266 patients undergoing head and neck free flap reconstruction from 2012 to 2017.
- Primary outcome: rate of any infection within 30 days of surgery.
- Comparison between short-course (24-72 hours) and extended-course (≥7 days) antibiotic prophylaxis.
Main Results:
- No significant difference in overall postoperative infection rates between short-course and extended-course antibiotic prophylaxis groups (p=0.80).
- Surgical site infections (92.6% of all infections) and distant infections (pneumonia, UTI) also showed no significant difference based on prophylaxis duration.
- Hypothyroidism and clean-contaminated wound classification were identified as risk factors for infection.
Conclusions:
- Shorter durations of ampicillin-sulbactam prophylaxis are safe and do not increase postoperative infection rates in head and neck free flap reconstruction.
- Findings suggest that current extended prophylaxis protocols may be unnecessarily long.
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