AI Article Synopsis
- Prophylactic antibiotics are frequently prescribed at discharge after mastectomy, even though guidelines advise against their use, leading to an investigation into their effectiveness and associated factors.
- The study analyzed data from 38,793 mastectomy procedures, revealing that 19.2% of mastectomy-only patients and 71.8% of those with immediate reconstruction received antibiotics after discharge.
- Results showed that while postdischarge anti-methicillin-sensitive (MSSA) antibiotics reduced surgical-site infections (SSI) for both groups, the high number needed to treat indicates that the benefits may not always outweigh the risks.
Article Abstract
Background: Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI).
Study Design: We studied a cohort of women aged 18-64 years undergoing mastectomy between January 1, 2010, and June 30, 2015, using the MarketScan commercial database. Patients with nonsurgical perioperative infections were excluded. Postdischarge oral antibiotics were identified from outpatient drug claims. SSI was defined using (ICD-9-CM) diagnosis codes. Generalized linear models were used to determine factors associated with postdischarge prophylactic antibiotic use and SSI.
Results: The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed after discharge after 2,688 mastectomy-only procedures (19.2%) and 17,807 mastectomies with immediate reconstruction (71.8%). The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with immediate reconstruction. Antibiotics with anti-methicillin-sensitive (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55-0.99) and mastectomy with immediate reconstruction (aRR, 0.80; 95% CI, 0.73-0.88), respectively. The numbers needed to treat to prevent 1 additional SSI were 107 and 48, respectively.
Conclusions: Postdischarge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. The high numbers needed to treat suggest that potential benefits of postdischarge antibiotics should be weighed against potential harms associated with antibiotic overuse.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957624 | PMC |
| http://dx.doi.org/10.1017/ice.2021.400 | DOI Listing |
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