(14) Are Postoperative Prophylactic Antibiotics Required in Complex Patients Undergoing Nasal Septorhinoplasty?

Abstract

Background: Minimizing surgical site infections and the associated morbidity in rhinoplasty surgery has resulted in 90% of these cases receiving antibiotic prophylaxis.1 The practice of prolonged antibiotic use concomitant with graft utilization and case complexity is frequently recommended.2

Purpose: To determine if an American Society of Anesthesiology (ASA) value of 3 in patients undergoing a complex septorhinoplasty is a risk factor for postoperative surgical site infection.Study design: Retrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Veterans Affair North Texas Health Care System in Dallas, Texas.Independent variable: The ASA classification system that reflects a patients physical health status, in particular values greater than or equal to 3, which represent severe systemic disease and functional limitations, was the independent variable. Main outcome variable: The main outcome variable of interest was the development of postoperative surgical site infection. This was defined as findings consistent with soft tissue infections that ranged from cellulitis, purulence, or fistula development that necessitated antibiotic treatment. Demographic: Patient as age in years and sex. Physiologic: Diagnosis of diabetes, and history of nasal trauma or previous nasal surgery. Social: Smoking status defined as current, former, or never smoker. Surgical: Duration greater or less than the mean, preoperative antibiotic administered, intraoperative complication, and type of cartilage graft used.Analyses: Chi square analysis and t-tests were used for calculations with P values < .05 being considered significant.

Results: A total of 182 patients were included in this study, 81 with an ASA ≤ 2 and 101 with an ASA of 3. There were a total of 6 SSIs resulting in a total postoperative infection rate of 3.3%, 2 were seen in those with an ASA of 3. Patients with an ASA of 3 were not at an increased risk of postoperative infection (n of 101, P = .27, OR of .39).

Conclusions: Our results suggest that an ASA of 3 is not significant with regards to postoperative infection in patients who undergo a complex nasal septorhinoplasty and prophylactic postoperative antibiotics are not warranted.References1. Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC: Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary. Otolaryngol--head neck surg 156: 205, 2017.2. Perrotti et al. Antibiotic use in esthetic surgery: a national survey and literature review. Plast Reconstr Surgery, 2002

Table 1. Characteristics of the Study Population
Table 2. Covariates against the primary predictor variables
Table 3. Covariates against the primary outcome variables