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What Is the Impact of Postoperative Antibiotic Prophylaxis on Tissue Expander Infection Rates in Pediatric Patients?
Howard D Wang1, Annie Cho1, Amy Quan1
1From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; and the Institute for Advanced Reconstruction.
Insights
Postoperative antibiotics did not significantly reduce infection or extrusion rates in pediatric tissue expander patients. A course of these antibiotics may not be necessary after insertion, simplifying care.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Infectious Disease
Background:
- Tissue expansion in children presents challenges with high infection and extrusion rates.
- Understanding factors influencing these complications is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the impact of postoperative antibiotic prophylaxis on infectious complications after pediatric tissue expander insertion.
- To identify predictors of infection and extrusion in this patient population.
Main Methods:
- Retrospective analysis of 180 pediatric patients undergoing 317 tissue expander insertions over 12 years.
- Comparison of outcomes between patients receiving perioperative (≤24 hours) versus extended postoperative antibiotics.
- Bivariate and multivariate analyses to assess the association of various factors with infection/extrusion.
Main Results:
- Overall infection/extrusion rate was 23%.
- No significant difference in infection (12.1% vs 8.9%), extrusion (16.8% vs 17.7%), or combined events (23.7% vs 24.1%) between antibiotic groups.
- Multivariate analysis showed no significant association between postoperative antibiotics and infection/extrusion (OR, 0.84; p=0.61).
Conclusions:
- Pediatric patients receiving only perioperative antibiotics had similar infection/extrusion rates compared to those on postoperative antibiotics.
- Extended postoperative prophylactic antibiotics may be unnecessary for pediatric tissue expander insertions.
Background:
Tissue expansion in the pediatric population can be complicated by high rates of infection and extrusion. The aim of this study was to examine the impact of postoperative antibiotic prophylaxis on infectious complications.
Methods:
A retrospective study of all pediatric patients who underwent tissue expander insertion at a children's hospital over a 12-year period was performed. Predictor variables included age, sex, race, indication, anatomical location, number of expanders inserted, serial expansion, history of infection or extrusion, and postoperative antibiotics. Outcome variables included infection and extrusion. Bivariate and multivariate analyses were performed to identify factors associated with infection and/or extrusion.
Results:
A total of 180 patients who underwent 317 operations for tissue expander insertion were included in this study. Postoperative infection and/or extrusion occurred after 73 operations (23 percent). Postoperative prophylactic antibiotics were prescribed after 232 operations (75 percent), and only perioperative (≤24 hours) antibiotics were administered in 85 cases (25 percent). There were no significant differences in the rate of infection (12.1 percent versus 8.9 percent; p = 0.46), extrusion (16.8 percent versus 17.7 percent; p = 0.88), or infection and/or extrusion (23.7 percent versus 24.1 percent; p = 0.95) between these two groups. Multivariate analysis revealed that postoperative antibiotics did not have a significant association with infection and/or extrusion (OR, 0.84; 95 percent CI, 0.44 to 1.63; p = 0.61).
Conclusions:
The rates of infection/extrusion were similar between pediatric patients who received only perioperative antibiotics (≤24 hours) and those who were prescribed a course of postoperative antibiotics. Based on these results, a course of postoperative prophylactic antibiotics may be unnecessary after insertion of tissue expanders in pediatric patients.
Clinical Question/Level Of Evidence:
Therapeutic, III.
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