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Prolonged prophylactic antibiotic use following megaprosthesis surgery may reduce periprosthetic infection
Ali Aneizi1, Murali Kovvur1, Matthew Chrencik1
1Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, United States.
Introduction:
Megaprostheses provide a reconstructive option for patients with bone loss after musculoskeletal tumor resection. However, the postoperative surgical site infection (SSI) risk is significant. This study aims to evaluate outcomes of extended postoperative antibiotic regimens in patients after megaprosthesis surgery and gather insight into strategies to minimize SSI.
Methods:
This retrospective cohort study evaluated patients who underwent megaprosthesis surgery by a single surgeon at a single center from 2014 to 2022. Patient demographics, comorbidities, cancer treatment details, and antibiotic regimens were collected. Excluded were patients with less than 1 year of follow-up, active infection at time of surgery, non-healing wounds unrelated to SSI, and preoperative antibiotic regimens secondary to being immunocompromised. Measures of interest included the development of SSI within 1 year of surgery and development of antibiotic-related complications.
Results:
Included were 49 patients, with a mean age of 61.2 ± 2.0 years and a mean BMI of 29.4 ± 7.0. The mean drain duration was 6.5 days (standard deviation [SD], 6.9 days), and the mean intravenous antibiotic administration duration was 6.4 days (SD, 6.9 days). The median time to drain removal was five days, and the median time for intravenous antibiotic cessation was five days. The mean total antibiotic administration duration (intravenous and oral) was 25.4 days (SD, 13.4 days). Only 1 patient in the included cohort (2.04 %) developed an SSI requiring operative intervention. No other patient within the cohort experienced an antibiotic-related complication.
Discussion:
This study suggests that the site's current protocol for managing post-megaprosthesis antibiotic prophylaxis based on drain duration and incision healing status has resulted in a low rate of SSI and antibiotic-related complications. Further research is needed to validate these findings and gain additional insights into managing antibiotic prophylaxis after megaprosthesis surgery.
Insights
Extended antibiotic prophylaxis after megaprosthesis surgery is effective in minimizing surgical site infections (SSI). This approach resulted in a low SSI rate of 2.04% and no antibiotic complications in patients.
Area of Science:
- Orthopedic Surgery
- Oncology
- Infectious Disease
Background:
- Megaprostheses are crucial for reconstructing bone defects after musculoskeletal tumor resection.
- Postoperative surgical site infections (SSI) pose a significant risk in megaprosthesis patients.
Purpose of the Study:
- To evaluate the outcomes of extended postoperative antibiotic regimens in patients undergoing megaprosthesis surgery.
- To identify strategies for minimizing SSI risk in this patient population.
Main Methods:
- Retrospective cohort study of 49 patients who underwent megaprosthesis surgery between 2014 and 2022.
- Data collected included patient demographics, comorbidities, cancer treatment, and antibiotic regimens.
- Exclusion criteria included less than 1 year follow-up, active infection, non-healing wounds, and preoperative antibiotic use for immunocompromise.
Main Results:
- The mean total antibiotic duration was 25.4 days.
- Only one patient (2.04%) developed an SSI requiring intervention.
- No antibiotic-related complications were observed in the cohort.
Conclusions:
- The current protocol for antibiotic prophylaxis, based on drain duration and wound healing, appears effective in reducing SSI rates.
- Further research is recommended to validate these findings and refine antibiotic prophylaxis strategies.
