Antibiotic Prophylaxis and Surgical Site Infections in Septoplasty

Surgical site infection is one of the most common complications of septoplasty. The use of antibiotic prophylaxis has been debated for years. Since the practice at our centre has shifted towards a more frequent use of prophylactic antibiotics in septoplasties, our aim was to review its use and effect on the postoperative infection rate.

We retrospectively reviewed the medical records of all adult patients who had undergone septoplasty at the Helsinki University Hospital (Helsinki, Finland) during 2019-2023. Patient and surgery characteristics, use of surgical antibiotic prophylaxis, surgical site infections and their management were reviewed.

The series consisted of 1169 septoplasties, and antibiotic prophylaxis was used in 90.1% of the cases. A postoperative infection was diagnosed in 1.9%. Longer operative time and the use of silicone splints were associated with a higher risk of postoperative infections (p = 0.007 and p = 0.03, respectively). There was no significant difference in the infection rate between those who received preoperative antibiotic prophylaxis and those who did not. Among those using a preoperative course of topical antibiotic cream, no infections were seen. Compared with previous studies on septoplasty infections at our centre, the infection rate has decreased whilst the use of antibiotic prophylaxis has increased.

Based on the present results, antibiotic prophylaxis does not affect postoperative infection rate after septoplasty. A preoperative course of nasal mupirocin seems to be a promising and less harm-causing form of prophylaxis. To confirm our results, there is a need for analysis of larger patient cohorts and prospective, controlled studies.