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Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence
BACKGROUND: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive a...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120557/ https://www.ncbi.nlm.nih.gov/pubmed/34026678 http://dx.doi.org/10.1177/2292550321997005 |
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author | Mankowski, Peter Cherukupalli, Abhiram Slater, Karen Carr, Nick |
author_facet | Mankowski, Peter Cherukupalli, Abhiram Slater, Karen Carr, Nick |
author_sort | Mankowski, Peter |
collection | PubMed |
description | BACKGROUND: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. METHODS: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. RESULTS: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. CONCLUSION: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations. |
format | Online Article Text |
id | pubmed-8120557 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-81205572021-05-21 Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence Mankowski, Peter Cherukupalli, Abhiram Slater, Karen Carr, Nick Plast Surg (Oakv) Original Articles BACKGROUND: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. METHODS: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. RESULTS: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. CONCLUSION: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations. SAGE Publications 2021-03-02 2021-05 /pmc/articles/PMC8120557/ /pubmed/34026678 http://dx.doi.org/10.1177/2292550321997005 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Articles Mankowski, Peter Cherukupalli, Abhiram Slater, Karen Carr, Nick Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence |
title | Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence |
title_full | Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence |
title_fullStr | Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence |
title_full_unstemmed | Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence |
title_short | Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence |
title_sort | antibiotic prophylaxis in plastic surgery correlation between practice and evidence |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120557/ https://www.ncbi.nlm.nih.gov/pubmed/34026678 http://dx.doi.org/10.1177/2292550321997005 |
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