National Practice Patterns in Preoperative and Postoperative Antibiotic Prophylaxis in Breast Procedures Requiring Drains: Survey of the American Society of Breast Surgeons

Abstract

Background The aim of this study was to assess national practice patterns regarding use of perioperative antibiotics by surgeons performing breast operations requiring drainage tubes. Methods The members of the American Society of Breast Surgeons (ASBrS) were surveyed regarding use of perioperative antibiotics for breast operations requiring drains, with or without immediate tissue expander or implant reconstruction. Results Of 2857 ASBrS members contacted, 917 (32%) responded and all self-identified as surgeons. Of 905 evaluable respondents, most described themselves as general surgeons (46%) or breast surgeons (46%). For cases in which drains are anticipated, most respondents (86%) reported routine use of preoperative prophylactic antibiotics, 99% selecting cephalosporins. Use of antibiotic >24 hours postoperatively varied by whether or not reconstruction was performed. In non-reconstruction cases, the majority (76%) reported “never/almost never” prescribing antibiotics beyond the 24 hour postoperative period, but 16% reported “always/almost always”. In reconstruction cases, the majority (58%) reported routine antibiotic use beyond 24 hours and the primary driver of the decision to use antibiotics was reported to be the plastic surgeon (83%). Among those reporting use >24 hours, the duration recommended for non-reconstruction cases was “up to one week” in 38% and “until drains removed” in 39%, and this was similar for reconstruction cases. Conclusions Cephalosporins are utilized uniformly as preoperative antibiotic prophylaxis in breast operations requiring drains. However, use of postoperative antibiotic prophylaxis is strongly dependent on the presence of immediate breast reconstruction. Consensus is lacking on the role of postoperative antibiotic prophylaxis in breast operations utilizing drains.

Should a Drain Be Placed in Early Breast Cancer Surgery?

“…1). Articles investigating different instruments/surgical techniques [25,26,27], postsurgical physiotherapy [28], or breast infections without relation to the insertion of drains [29,30] were excluded. This left the 3 articles from Taylor et al [5], Andeweg et al [31], and Garbay et al [32].…”

Clinical and Microbiological Characterization of Late Breast Implant Infections after Reconstructive Breast Cancer Surgery

“…The present work describes a prospectively collected single-center case series evaluation and shows that, when based on clinical definition, late breast implant infection after [3,6,9,10]. A subsequent epidemiological definition suggested in order to avoid underreporting, to extend the ''early'' period up to 1 y after surgery thus encompassing distinct clinical stages in the case of breast reconstruction.…”

“…There is, however, still controversy in the breast reconstruction area on the definition of infection and on the observation time required to define actual implant infection. Indeed, in this regard, early reports studied implant infection using a limited time of observation more useful for surgical site infection (SSI) evaluation [3,9,10] and not for prostetic infection.…”

“…With regard to timing of post-surgical implant infection, agreement is found in time designations for late infections in other areas of prosthetic surgery. This is, for example, the case in prosthetic joint surgery where late and very late infections are defined when occurring after 3-24 mo and >24 mo [12], heart valve surgery (2 mo to 1 y and >1 y), and vascular prosthetic surgery (>4 mo) [9,13,14].…”

Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Three)

“…In a survey of the members of the American Society of Breast Surgeons regarding the use of perioperative antibiotics for breast operations requiring drains, respondents continued antibiotic prophylaxis for 2 -7 days or until all drains were removed (38% and 39%, respectively) in cases without reconstruction, while in reconstruction cases 33% of respondents continued antibiotic prophylaxis for 2 -7 days or until all drains were removed (63). A similar study surveying the American and Canadian societies of plastic surgeons regarding drain use and perioperative antibiotic prophylaxis in cases of breast reconstruction found that 72% of plastic surgeons prescribed postoperative outpatient antibiotics in reconstruction patients with drains, with 46% continuing antibiotics until drains were removed (64).…”