Groin dissections in skin cancer: Effect of a change in prophylactic antibiotic protocol
Dallan Dargan1, Sandip Hindocha2, Max Hadlett3
1Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom.
Objectives:
To determine whether groin dissection surgical site infection (SSI) incidence changed with shorter post-operative antibiotic prophylaxis.
Background:
Post-operative prophylaxis changed due to antimicrobial stewardship, from regular oral antibiotics until drain removal, to three intravenous doses. Both groups had a single intravenous dose at induction.
Methods:
A prospective database of groin dissections for metastatic skin cancer was retrospectively reviewed for SSI according to Public Health England criteria. Eighty groin dissections in 79 consecutive patients were included: 40 had oral antibiotics until drain removal [mean 26±7 (range 19-36) days] and 39 had three post-operative intravenous doses.
Results:
Longer prophylaxis was associated with lower SSI incidence [10 (25%) versus 21 (54%), odds ratio (OR) 3.50, 95% confidence interval (CI) 1.34-9.08, p = 0.009], fewer deep infections [5 (13%) versus 16 (41%), OR 4.89, 95% CI 1.57-15.13, p = 0.004], fewer readmissions for infection [5 (13%) versus 15 (38%), OR 4.38, 95% CI 1.40-13.65, p = 0.008], but similar seroma incidence [18 (45%) versus 16 (41%), OR 0.85, 95% CI 0.35-2.07, p = 0.72] and wound dehiscence [7 (18%) versus 5 (13%), OR 0.69, 95% CI 0.20-2.40, p = 0.56]. BMI ≥30 (n = 21) was associated with SSI, occurring in 13 of 21 (62%) (OR 3.859, 95% CI 1.34-11.10, p = 0.01). Median infection onset was 22 days (IQR 12-27) versus 17 (IQR 13-22), (p = 0.53). Multiple organisms were cultured in 21 of 31 (68%) patients with positive microbiological samples.
Conclusions:
SSI rates doubled with shorter prophylaxis; deep infections and readmissions for infection tripled. Obesity was independently associated with infection. Seroma and wound dehiscence incidence were unchanged. Infections mainly occurred in the third week after surgery and were polymicrobial.
Insights
Shorter post-operative antibiotic prophylaxis for groin dissection doubled surgical site infection (SSI) rates, tripling deep infections and readmissions. Obesity was also linked to increased infection risk in this study.
Area of Science:
- Surgical oncology
- Infectious disease epidemiology
- Antimicrobial stewardship
Background:
- Antimicrobial stewardship initiatives prompted a change in post-operative antibiotic prophylaxis for groin dissections.
- Prophylaxis shifted from extended oral antibiotics to a shorter course of three intravenous doses, with all patients receiving a single dose at induction.
Purpose of the Study:
- To evaluate the impact of reduced post-operative antibiotic prophylaxis duration on surgical site infection (SSI) incidence following groin dissection.
- To identify risk factors associated with SSI in patients undergoing groin dissection.
Main Methods:
- A retrospective review of a prospective database of 80 groin dissections in 79 patients with metastatic skin cancer.
- Patients were categorized into two groups: those receiving oral antibiotics until drain removal (longer prophylaxis) and those receiving three post-operative intravenous doses (shorter prophylaxis).
- SSI was assessed using Public Health England criteria.
Main Results:
- Shorter prophylaxis was associated with a significant increase in SSI incidence (54% vs. 25%), with doubled rates.
- Deep infections and readmissions for infection were tripled in the shorter prophylaxis group.
- Obesity (BMI ≥30) was an independent risk factor for SSI (62% incidence).
- Seroma and wound dehiscence rates remained similar between groups.
Conclusions:
- Reducing the duration of post-operative antibiotic prophylaxis for groin dissection significantly increases SSI rates, deep infections, and readmissions.
- Obesity is a critical independent risk factor for surgical site infections after groin dissection.
- The findings underscore the importance of optimizing antibiotic prophylaxis duration in surgical procedures to mitigate infection risk.
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