Effectiveness of Prophylactic Antibiotics in Outpatient Plastic Surgery

Background: The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making. Methods: We searched for peer-reviewed literature describing how plastic surgeons might positively affect the environment through action in the operating room. Results: Several evidence-based, pro-climate practices may be undertaken by plastic surgeons. These strategies may be grouped into 4 types: material, energy, technique, and dissemination. Each strategy is a way to reduce, reuse, recycle, research, or rethink. Conclusions: Administrative obstacles to greener operating rooms are predictable and surmountable, especially because environmentally minded decisions are likely to save money. We anticipate a surge of environmental consciousness in healthcare. Plastic surgeons, as thought leaders, are well positioned to champion this cause.

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“… 31 – 33 Several authors have argued that prophylactic antibiotics are not necessary in much of plastic surgery. 33 – 36 …”

Section: Resultsmentioning

confidence: 99%

Four Ways Plastic Surgeons Can Fight Climate Change

Brown

Meals

2020

Plastic and Reconstructive Surgery - Global Open

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“…According to a 6-year study by Baran et al,17 there was no significant difference in infection rates between a group of patients treated with antibiotics and a group not treated with antibiotics. Anigian et al18 also demonstrated that postoperative administration of antibiotics did not result in lower morbidity rates than preoperative administration alone, and Hunter et al19 recommended the discontinuation of prophylactic antibiotics within 24 hours after surgery as part of the recommendations for prophylactic antibiotic use in plastic surgery. Conversely, there are several studies demonstrating the benefits of postoperative antibiotic use.…”

Section: Discussionmentioning

confidence: 99%

Appropriate Prophylactic Antibiotic Use in Clean Wound Surgery Under Local Anesthesia

et al. 2019

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Background Although guidelines to prevent surgical site infections (SSIs) were published more than a decade ago, prophylactic antibiotics are still used subjectively in clinical practice. In this study, we evaluated the safety of single-dose preoperative intravenous antibiotics without postoperative antibiotics in the field of clean wound surgery performed under local anesthesia. We also surveyed the present clinical conditions for prophylactic antibiotic use in the plastic surgery departments of training hospitals in Korea. Methods A total of 360 consecutive patients who underwent clean wound surgery under local anesthesia in an outpatient clinic from March 2018 to October 2018 were reviewed. In the study group, a single surgeon administered first-generation cephalosporins intravenously within 1 hour of skin incision and did not prescribe additional antibiotics. In the control group, 2 other surgeons prescribed oral first-generation cephalosporins postoperatively for 2 to 3 days without preoperative antibiotics. A telephone survey about perioperative antibiotic regimens was conducted at the departments of plastic surgery in training hospitals. Results There were 128 patients in the study group and 232 patients in the control group. There were no significant differences between the 2 groups regarding SSIs and other surgical complications. A total of 41 training hospitals answered the survey and every hospital had protocols of prescribing postoperative oral antibiotics routinely at the time of discharge with a mean duration of 3.9 days. Only 11 hospitals (26.8%) prescribed parenteral antibiotics before surgery as well as postoperative oral antibiotics. Conclusion Intravenous injection of single-dose first-generation cephalosporins 1 hour before surgery without postoperative antibiotics did not increase the incidence of SSIs compared with the usual practice of giving only postoperative antibiotics prescription for 2 to 3 days in cases of clean wound surgery performed under local anesthesia. Proper antibiotic prophylaxis should be performed by surgeons in training hospitals without hesitation.

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“…Anigian et al 9 show that difference in timing of prophylaxis did not affect their complication rate, and they debate the effectiveness for prophylaxis in clean cases. Hsu et al analyzed the studies looking at breast and other elective surgery—despite the use of implants and nipple contamination risk, there was a minimal difference in SSI in breast augmentations when antibiotic prophylaxis was used (0%–0.7%); however, in clean-contaminated cases such as rhinoplasty, there was a significant difference between prophylactic and nonprophylactic group (0%–8.9%).…”

Section: Discussionmentioning

confidence: 99%

“…1 Through records and codes, Centers for Medicare and Medicaid Services quality indicators show that smaller office-based suites and ambulatory surgical centers perform better than hospitals 9,10 ; yet do not provide adequate information or basis to compare elective aesthetic surgery infection rates. Even national databases that include cosmetic surgery data, such as the National Surgical Quality Improvement Program or Tracking Operations and Outcomes for Plastic Surgeons, are still difficult to analyze because certain variables are unsearchable, are unspecific input narrows specificity by procedure, and can include subjective details during input.…”

Section: Discussionmentioning

confidence: 99%

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Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery

LaBove¹,

Davison

Jackson

2016

Plastic and Reconstructive Surgery - Global Open

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Background:A best practice goal to reduce surgical site infection includes administration of antibiotics in the ideal preoperative window. This article evaluates an office surgical suite antibiotic administration rate and compares it with the timing of a local hospital treating a similar patient population. The hypothesis was that similar or better compliance and surgical site infection rates can be achieved in the office-based suite.Methods:A total of 277 office-based surgeries were analyzed for antibiotic administration time before incision and their corresponding surgical site infection rate.Results:Our facility administered timely prophylactic antibiotics in 96% of cases with a surgical site infection rate of 0.36%. This rate was significantly lower than a reported rate of 3.7%.Conclusion:Low infection rates with high antibiotic administration rate suggest that compliance with best possible practice protocols is possible in the outpatient setting.

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Effectiveness of Prophylactic Antibiotics in Outpatient Plastic Surgery

Abstract: 3.

Cited by 14 publications

References 9 publications

Four Ways Plastic Surgeons Can Fight Climate Change

Four Ways Plastic Surgeons Can Fight Climate Change

Appropriate Prophylactic Antibiotic Use in Clean Wound Surgery Under Local Anesthesia

Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery

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