1
|
Kim DK, Feuer GB, Warner PE, Ascherman JA. Predictors of extended length of stay following outpatient reduction mammaplasty. J Plast Reconstr Aesthet Surg 2024; 94:141-149. [PMID: 38781834 DOI: 10.1016/j.bjps.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Reduction mammaplasty has transitioned into a largely outpatient procedure in the United States. Following planned outpatient procedures, patients may still be admitted for additional inpatient care, incurring clinical and economic burden. Prior literature has not explored the preoperative and perioperative determinants of extended lengths of stay (LOS) after breast reduction surgery. METHODS Patients who underwent scheduled outpatient reduction mammaplasty were identified via current procedural terminology code from the 2013 to 2021 National Surgical Quality Improvement Program databases. The primary outcome was extended LOS, defined as an LOS greater than 1 day. The most significant predictor variables were identified through bivariate association, and a binary logistic regression model was used to characterize predictive associations (p < 0.05). RESULTS In this study, 33,924 patients were included in the final cohort of planned outpatient reduction mammaplasty cases. Among them 325 (1.0%) patients had extended LOS. Concurrent liposuction, body contouring, and increased operative time were the most significant predictors of extended LOS (p < 0.001), followed by older age, higher body mass index, bleeding disorder, history of diabetes, higher American Society of Anesthesiologists class, and White race (p < 0.05). When adjusted for other confounding variables, extended LOS was also a significant predictor of increased risk of postoperative complications after discharge (OR: 1.85, 95% confidence intervals: 1.27-2.69, p = 0.0012). CONCLUSION Extended LOS after planned outpatient reduction mammaplasty is associated with specific comorbidities, and is a significant predictor of postoperative complications following hospital discharge. DATA AVAILABILITY STATEMENT The data that support the findings of this study are publicly available.
Collapse
Affiliation(s)
- Dylan K Kim
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA
| | - Grant B Feuer
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA
| | - Paige E Warner
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA
| | - Jeffrey A Ascherman
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, 161 Fort Washington Ave. - Ste. 511, New York 10032, NY, USA.
| |
Collapse
|
2
|
Stojičić M, Jurišić M, Marinković M, Jovanović M, Igić A, Nikolić Živanović M. Necrotizing Skin and Soft Tissue Infection after Gluteal Augmentation in a Perioperatively Asymptomatic COVID-19 Patient-Complications of the Post-Lockdown Era? A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050914. [PMID: 37241146 DOI: 10.3390/medicina59050914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Introduction: Aesthetic surgery procedures are generally done in a relatively healthy population and carry a rather low risk compared to other surgical specialties. The incidence of complications in aesthetic surgery varies greatly depending on the type, wound cleanliness regarding the anatomical site, complexity of the surgery, patient's age, and comorbidities but is generally considered low. The overall incidence of surgical site infections (SSIs) in all aesthetic surgical procedures is around 1% in most of the literature while cases of necrotizing soft tissue infections are mostly found as individual reports. In contrast, treating COVID-19 patients is still challenging with many diverse outcomes. Surgical stress and general anesthesia are known mediators of cellular immunity impairment while studies regarding COVID-19 infection unquestionably have shown the deterioration of adaptive immunity by SARS-CoV-2. Adding COVID-19 to the modern surgical equation raises the question of immunocompetence in surgical patients. The main question of the modern post-lockdown world is: what could be expected in the postoperative period of perioperatively asymptomatic COVID-19 patients after aesthetic surgery? Case report: Here, we present a purulent, complicated, necrotizing skin and soft tissue infection (NSTI) after gluteal augmentation most likely triggered by SARS-CoV-2-induced immunosuppression followed by progressive COVID-19 pneumonia in an otherwise healthy, young patient. To the best of our knowledge, this is the first report of such adverse events in aesthetic surgery related to COVID-19. Conclusion: Aesthetic surgery in patients during the incubation period of COVID-19 or in asymptomatic patients could pose a significant risk for surgical complications, including severe systemic infections and implant loss as well as severe pulmonary and other COVID-19-associated complications.
Collapse
Affiliation(s)
- Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksa Igić
- Center for Radiology and Magnetic Resonance Imaging, Department of Interventional Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Maja Nikolić Živanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| |
Collapse
|
3
|
Homsy P, Romo I, Kauhanen S. Antibiotic prophylaxis in clean and clean-contaminated plastic surgery: A critical review. J Plast Reconstr Aesthet Surg 2023; 83:233-245. [PMID: 37285776 DOI: 10.1016/j.bjps.2023.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
Antibiotic prophylaxis is frequently used in plastic surgery procedures, despite the generally low rates of infection and few guidelines on the practice. The increasing prevalence of bacterial resistance to antibiotics calls for a reduction in unnecessary antibiotic use. The aim of this review was to create an updated summary of the available data on the effectiveness of antibiotic prophylaxis in reducing the postoperative infection in clean and clean-contaminated plastic surgery. A systematic literature search was performed on the databases Medline, Web of Science, and Scopus, limited to articles published January 2000 onward. Randomized controlled trials (RCTs) were included in the primary review, whereas older RCTs and other studies were sought if 2 or fewer relevant RCTs were identified. Overall, 28 relevant RCTs, 2 nonrandomized trials, and 15 cohort studies were identified. Although the number of studies for each type of surgery is limited, the data suggest that prophylactic systemic antibiotic may be unnecessary in noncontaminated facial plastic surgery, reduction mammaplasty, and breast augmentation. In addition, no benefit is apparent from extending the antibiotic prophylaxis over 24 h in rhinoplasty, aerodigestive tract reconstruction, and breast reconstruction. No studies assessing the necessity of antibiotic prophylaxis in abdominoplasty, lipotransfer, soft tissue tumor surgery, or gender affirmation surgery were identified. In conclusion, limited data are available on the effectiveness of antibiotic prophylaxis in clean and clean-contaminated plastic surgery. More studies on this topic are needed before strong recommendations can be made on the use of antibiotics in this setting.
Collapse
Affiliation(s)
- Pauliina Homsy
- Department of Plastic Surgery, Puistosairaala, University of Helsinki and Helsinki University Central Hospital, P.O. Box 281, 00029 HUS, Finland.
| | - Inka Romo
- Department of Infectious Diseases, Meilahden Kolmiosairaala, University of Helsinki and Helsinki University Central Hospital, P.O. Box 372, 00029 HUS, Finland
| | - Susanna Kauhanen
- Department of Plastic Surgery, Puistosairaala, University of Helsinki and Helsinki University Central Hospital, P.O. Box 281, 00029 HUS, Finland
| |
Collapse
|
4
|
Lu J, Jiang X, Huang H, Tang L, Zou X, Mao H, Liu H. Infectious shock after liposuction. BMC Infect Dis 2022; 22:617. [PMID: 35840943 PMCID: PMC9287851 DOI: 10.1186/s12879-022-07574-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/28/2022] [Indexed: 03/14/2024] Open
Abstract
Background Liposuction has become one of the most popular cosmetic surgeries in China. However, few studies have discussed infectious shock caused by C. perfringens as one of the causes of death after liposuction. Case presentation A 24-year-old woman was brought to the emergency department (ED) of Guangzhou Chinese Overseas Hospital for treatment. The patient had undergone liposuction in her bilateral lower limbs two days prior. At the ED, the patient was unconscious, and had bilateral equal-sized (diameter, 6 mm) round pupils, no light reflex, a blood pressure (BP) of 71/33 mmHg, a heart rate of 133 bpm, and an SpO2 of 70%. She had bilateral limb swelling, extensive ecchymoses in her lower abdomen and bilateral thighs, local crepitus, blisters, weak pulses on her femoral artery and dorsalis pedis, high skin tension, and hemoglobin of 32 g/L. The patient was diagnosed with Clostridium perfringens infection, and she underwent debridement surgery and supportive treatment. But the patient’s BP could not improve. At 8:28 pm on the day of admission, the patient was declared clinically dead after the electrocardiograph showed a horizontal line and spontaneous respiration ceased. Conclusions Failure to meet surgical disinfection and environmental standards may be the cause of infection of C. perfringens through wounds. Therefore, it is necessary to strengthen the environmental disinfection of the operating room, and standardize the sterile conditions of the operation staff and patients before and during operation. Liposuction surgery necrotizing fasciitis is a rare but fatal complications, especially if diagnosis delay, therefore it is critical for early diagnosis and treatment of gas gangrene. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07574-1.
Collapse
Affiliation(s)
- Jinqiang Lu
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China
| | - Xiao Jiang
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China
| | - Hongyin Huang
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China
| | - Lingzhi Tang
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China
| | - Xinhui Zou
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China
| | - Haoran Mao
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China
| | - Hongwei Liu
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China. .,Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Huangpu West Road 613, Guangdong Province, 510630, Guangzhou, People's Republic of China.
| |
Collapse
|
5
|
Bittencourt TL, da Silva Prata RB, de Andrade Silva BJ, de Mattos Barbosa MG, Dalcolmo MP, Pinheiro RO. Autophagy as a Target for Drug Development Of Skin Infection Caused by Mycobacteria. Front Immunol 2021; 12:674241. [PMID: 34113346 PMCID: PMC8185338 DOI: 10.3389/fimmu.2021.674241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Pathogenic mycobacteria species may subvert the innate immune mechanisms and can modulate the activation of cells that cause disease in the skin. Cutaneous mycobacterial infection may present different clinical presentations and it is associated with stigma, deformity, and disability. The understanding of the immunopathogenic mechanisms related to mycobacterial infection in human skin is of pivotal importance to identify targets for new therapeutic strategies. The occurrence of reactional episodes and relapse in leprosy patients, the emergence of resistant mycobacteria strains, and the absence of effective drugs to treat mycobacterial cutaneous infection increased the interest in the development of therapies based on repurposed drugs against mycobacteria. The mechanism of action of many of these therapies evaluated is linked to the activation of autophagy. Autophagy is an evolutionary conserved lysosomal degradation pathway that has been associated with the control of the mycobacterial bacillary load. Here, we review the role of autophagy in the pathogenesis of cutaneous mycobacterial infection and discuss the perspectives of autophagy as a target for drug development and repurposing against cutaneous mycobacterial infection.
Collapse
Affiliation(s)
| | | | | | | | - Margareth Pretti Dalcolmo
- Helio Fraga Reference Center, Sergio Arouca National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Xie Y, Brenner MJ, Sand JP, Desai SC, Drumheller CM, Roberson DW, Nussenbaum B, Kienstra MA. Adverse events in facial plastic surgery: Data-driven insights into systems, standards, and self-assessment. Am J Otolaryngol 2021; 42:102792. [PMID: 33160176 DOI: 10.1016/j.amjoto.2020.102792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Complications in facial plastic surgery can lead to pain, suffering, and permanent harm. Yet, the etiology and outcomes of adverse events are understudied. This study aims to determine the etiology and outcomes of adverse events reported in aesthetic facial plastic surgery and identify quality improvement opportunities. MATERIAL AND METHODS A cross-sectional survey analysis was conducted using an anonymous 22-item questionnaire distributed to members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Participants were queried on demographics, practice type, and adverse events related to aesthetic facial surgeries. RESULTS Two hundred fifty-three individuals participated; nearly half of respondents (49.0%) held membership in both AAO-HNS and AAFPRS. Of these, 40.8% of respondents reported at least one adverse event within the past 12 months of practice. A total of 194 adverse events were reported, most commonly related to facelift (n = 59/194, 30.4%), rhinoplasty (n = 55/194, 28.4%), and injection procedures (n = 38/194, 19.6%), with hematoma or seroma being the most commonly described. Most adverse events were self-limited, but approximately 68% resulted in further procedures. Surgeon error or poor judgement (n = 42) and patient non-adherence (n = 18) were the most commonly ascribed reasons for adverse events; 37.1% of participants reported a change in clinical practice after the incident. CONCLUSIONS Adverse events were not infrequent in facial plastic surgery. Understanding these adverse events can provide impetus for tracking outcomes, standardization, and engagement with lifelong learning, self-assessment, and evaluation of practice performance.
Collapse
|
7
|
Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ. Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 2020; 21:179-189. [PMID: 33207164 PMCID: PMC7673892 DOI: 10.5811/westjem.2020.6.46415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.
Collapse
Affiliation(s)
- Tim Montrief
- University of Miami Miller School of Medicine, Department of Emergency Medicine, Miami, Florida
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Ramzy
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Brit J Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| |
Collapse
|
8
|
Maione V, Miccio L, Sala R, Calzavara-Pinton P. Anaerobic infection simulating necrotizing fasciitis, induced by liposuction for surgical treatment of siliconoma. Dermatol Ther 2020; 33:e13583. [PMID: 32410308 DOI: 10.1111/dth.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Vincenzo Maione
- Department of Dermatology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Laura Miccio
- Department of Dermatology, Spedali Civili, University of Brescia, Brescia, Italy
| | - Raffaella Sala
- Department of Dermatology, Spedali Civili, University of Brescia, Brescia, Italy
| | | |
Collapse
|
9
|
|
10
|
Kaoutzanis C, Ganesh Kumar N, Winocour J, Hood K, Higdon KK. Surgical Site Infections in Aesthetic Surgery. Aesthet Surg J 2019; 39:1118-1138. [PMID: 30892625 DOI: 10.1093/asj/sjz089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors and varies depending on the specific operation performed. Understanding the risk factors for infection development is critical because careful patient selection and appropriate perioperative counseling will set the right expectations and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course, and avoid long-term sequelae.
Collapse
Affiliation(s)
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| | - Keith Hood
- Department of Surgery, Division of Plastic Surgery, Rush University Medical Center, Chicago, IL
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| |
Collapse
|
11
|
Hwang I, Myung Y, Park S. Levator Pull-Out Suture Technique for Immediate Postoperative Correction of Eyelid Asymmetry After Ptosis Surgery in Asians. Aesthetic Plast Surg 2019; 43:388-394. [PMID: 30483936 DOI: 10.1007/s00266-018-1276-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative eyelid asymmetry is the most common complaint of patients after undergoing blepharoplasty and ptosis correction surgery. Calibrating eyelid asymmetry during ptosis correction surgery is still difficult for surgeons despite the development of innovative procedures. Our levator pull-out suture technique for correcting postoperative eyelid asymmetry after ptosis surgery is introduced. METHODS A total of 330 patients who underwent ptosis correction surgery with upper blepharoplasty from 2016 to 2017 were enrolled in our study. All surgeries were performed using the levator pull-out suture technique, and the postoperative eyelid asymmetry was corrected in the outpatient clinic at 2-3 days after the operation. Patient satisfaction was evaluated preoperatively and at 1 week and 2 months postoperatively using a questionnaire. Visual acuity, marginal reflex distance 1 (MRD1), and vertical palpebral fissure length asymmetry were measured preoperatively and compared to values taken postoperatively. RESULTS Patient satisfaction regarding asymmetry increased from 2.7/5 (preoperatively) to 4.1/5 points (postoperatively). MRD1 and vertical palpebral fissure length increased from 1.1/1.2 and 6.8/6.8 mm (preoperatively), respectively, to 2.8/2.9 and 8.5/8.6 mm (postoperatively), respectively. The asymmetry of MRD1 and vertical palpebral fissure length before and after surgery were corrected from 0.45/1.81 to 0.01/0.19 mm (p < 0.01). CONCLUSION Our innovative surgical method of using the levator pull-out suture technique is relatively simple and allows for finer suture adjustments postoperatively to effectively correct eyelid asymmetry, with satisfactory results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Inseok Hwang
- Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea
| | - Yujin Myung
- Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea
| | - Sanghoon Park
- Department of Plastic Surgery, ID Hospital, 142 Dosan dae-ro, Gangnam-gu, Seoul, 06039, Korea.
| |
Collapse
|
12
|
Influence of dressing application time after breast augmentation on cutaneous colonization: A randomized clinical trial. J Plast Reconstr Aesthet Surg 2018; 71:906-912. [DOI: 10.1016/j.bjps.2018.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/21/2018] [Indexed: 01/09/2023]
|
13
|
Kaoutzanis C, Winocour J, Yeslev M, Gupta V, Asokan I, Roostaeian J, Grotting JC, Higdon KK. Aesthetic Surgical Procedures in Men: Major Complications and Associated Risk Factors. Aesthet Surg J 2018; 38:429-441. [PMID: 29045566 DOI: 10.1093/asj/sjx161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/08/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The number of men undergoing cosmetic surgery is increasing in North America. OBJECTIVES To determine the incidence and risk factors of major complications in males undergoing cosmetic surgery, compare the complication profiles between men and women, and identify specific procedures that are associated with higher risk of complications in males. METHODS A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Gender specific procedures were excluded. Primary outcome was occurrence of a major complication in males requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for major complications including age, body mass index (BMI), smoking, diabetes, type of surgical facility, type of procedure, and combined procedures. RESULTS Of the 129,007 patients, 54,927 underwent gender nonspecific procedures, of which 5801 (10.6%) were males. Women showed a higher mean age (46.4 ± 14.1 vs 45.2 ± 16.7 years, P < 0.01). Men had a higher BMI (27.2 ± 4.7 vs 25.7 ± 4.9 kg/m2, P < 0.01), and were more likely to be smokers (7.1% vs 5.7%, P < 0.01) when compared to women. Men demonstrated similar overall major complication rates compared to women (2.1% vs 2.1%, P = 0.97). When specific complications were analyzed further, men had higher hematoma rates, but lower incidence of surgical site infection. Additionally, major complications after abdominoplasty, facelift surgery, and buttock augmentation were noted to preferentially affect males. On multivariate analysis, independent predictors of major complications in males included BMI (RR 1.05), hospital or ambulatory surgery center procedures (RR 3.47), and combined procedures (RR 2.56). CONCLUSIONS Aesthetic surgery in men is safe with low major complication rates. Modifiable predictors of complications included BMI and combined procedures. LEVEL OF EVIDENCE 2
Collapse
Affiliation(s)
| | - Julian Winocour
- Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, CA
| | - Max Yeslev
- Southeast Permanente Medical Group, Atlanta, GA
| | - Varun Gupta
- Prima Center for Plastic Surgery, Duluth, GA
| | - Ishan Asokan
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN
| | - Jason Roostaeian
- Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, CA
| | - James C Grotting
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL
- CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| |
Collapse
|
14
|
Kaoutzanis C, Gupta V, Winocour J, Layliev J, Ramirez R, Grotting JC, Higdon K. Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures. Aesthet Surg J 2017; 37:680-694. [PMID: 28430878 DOI: 10.1093/asj/sjw243] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Liposuction is among the most commonly performed aesthetic procedures, and is being performed increasingly as an adjunct to other procedures. OBJECTIVES To report the incidence and risk factors of significant complications after liposuction, and to determine whether adding liposuction to other cosmetic surgical procedures impacts the complication risk. METHODS A prospective cohort of patients who underwent liposuction between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications requiring emergency room visit, hospital admission, or reoperation within 30 days of the operation. Univariate and multivariate analysis evaluated risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, and combined procedures. RESULTS Of the 31,010 liposuction procedures, only 11,490 (37.1%) were performed as a solitary procedure. Liposuction alone had a major complication rate of 0.7% with hematoma (0.15%), pulmonary complications (0.1%), infection (0.1%), and confirmed venous thromboembolism (VTE) (0.06%) being the most common. Independent predictors of major complications included combined procedures (Relative Risk (RR) 4.81), age (RR 1.01), BMI (RR 1.05), and procedures performed in hospitals (RR 1.36). When examining specifically other aesthetic procedures performed alone or with liposuction, combined procedures had a higher risk of confirmed VTE (RR 5.65), pulmonary complications (RR 2.72), and infection (RR 2.41), but paradoxically lower hematoma risk (RR 0.77) than solitary procedures. CONCLUSIONS Liposuction performed alone is a safe procedure with a low risk of major complications. Combined procedures, especially on obese or older individuals, can significantly increase complication rates. The impact of liposuction on the risk of hematoma in combined procedures needs further investigation. LEVEL OF EVIDENCE 2
Collapse
Affiliation(s)
- Christodoulos Kaoutzanis
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Julian Winocour
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - John Layliev
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Roberto Ramirez
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C. Grotting
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Kent Higdon
- Drs Kaoutzanis, Winocour, Layliev, and Ramirez are Plastic Surgery Fellows, and Drs Gupta and Higdon are Assistant Professors, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| |
Collapse
|
15
|
Kaoutzanis C, Gupta V, Winocour J, Shack B, Grotting JC, Higdon K. Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 Patients. Aesthet Surg J 2017; 37:89-99. [PMID: 27694451 DOI: 10.1093/asj/sjw100] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent one of the most common postoperative complications in patients undergoing aesthetic surgery. OBJECTIVES This study reports the incidence and risk factors of major SSIs following aesthetic surgery. METHODS A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a major SSI requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for SSIs including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. RESULTS A total of 129,007 patients were identified, of which 599 (0.46%) had a major SSI. Mean age (43.8 ± 12.4 years vs 40.9 ± 13.9 years, P < .01) and BMI (27.3 ± 5.5 kg/m2 vs 24.3 ± 4.6 kg/m2, P < .01) were higher in patients with SSIs. Patients with a SSI were more likely to be smokers (10.5% vs 8.2%, P = .04) and diabetic (4.5% vs 1.8%, P < .01). Females suffered more SSI than males (0.5% vs 0.3%, P = .02). Trunk/extremity procedures had a higher incidence of SSI compared to breast or face procedures (0.9% vs 0.2%, P < .01). On multivariate analysis, independent predictors of SSI included age (Relative Risk [RR] 1.01), female gender (RR 1.86), BMI (RR 1.07), smoking (RR 1.61), diabetes (RR 1.58), hospital or ambulatory surgery center procedures (RR 1.39), trunk/extremity procedures (RR 2.42), and combined procedures (RR 1.88). CONCLUSIONS SSIs following cosmetic surgical procedures are associated with numerous independent predictors, which should be taken into consideration when counseling patients undergoing aesthetic surgery. LEVEL OF EVIDENCE 2 Risk.
Collapse
Affiliation(s)
- Christodoulos Kaoutzanis
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Julian Winocour
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Bruce Shack
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Kent Higdon
- Drs Kaoutzanis and Winocour are Plastic Surgery Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| |
Collapse
|
16
|
Sexton ME, Jacob JT. Commentary on: Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 Patients. Aesthet Surg J 2017; 37:100-102. [PMID: 27756737 DOI: 10.1093/asj/sjw167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mary Elizabeth Sexton
- From the Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jesse T Jacob
- From the Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
17
|
Park BY, Kwon JW, Kang SR, Hong SE. Analysis of Malpractice Claims Associated with Surgical Site Infection in the Field of Plastic Surgery. J Korean Med Sci 2016; 31:1963-1968. [PMID: 27822936 PMCID: PMC5102861 DOI: 10.3346/jkms.2016.31.12.1963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/21/2016] [Indexed: 11/20/2022] Open
Abstract
Postoperative infections are rare after plastic surgery; however, when present, they can affect the aesthetic outcome. Currently, many malpractice lawsuits are associated with surgical site infection. The present study aimed to analyze malpractice claims associated with surgical site infection in the field of plastic surgery through a review of Korean precedents. We analyzed the type of procedure, associated complications, and legal judgment in these cases. Most claimants were women, and claims were most often related to breast surgery. The common complications related to surgical site infection were deformity, scar, and asymmetry. Among the 40 cases, 34 were won by the plaintiff, and the mean claim settlement was 2,832,654 KRW (USD 2,636.6). The reasons for these judgements were as follows: 1) immediate bacterial culture tests were not performed and appropriate antibiotics were not used; 2) patients were not transferred to a high-level hospital or the infection control department was not consulted; 3) surgical site infection control measures were not appropriate; and 4) surgical procedures were performed without preoperative explanation about surgical site infection. The number of claims owing to surgical site infection after surgery is increasing. Infection handling was one of the key factors that influenced the judgement, and preoperative explanation about the possibility of infection is important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns.
Collapse
Affiliation(s)
- Bo Young Park
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jung Woo Kwon
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - So Ra Kang
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seung Eun Hong
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
| |
Collapse
|
18
|
Pluvy I, Panouillères M, Garrido I, Pauchot J, Saboye J, Chavoin J, Tropet Y, Grolleau J, Chaput B. Smoking and plastic surgery, part II. Clinical implications: A systematic review with meta-analysis. ANN CHIR PLAST ESTH 2015; 60:e15-49. [DOI: 10.1016/j.anplas.2014.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
|
19
|
Application time for postoperative wound dressing following breast augmentation with implants: study protocol for a randomized controlled trial. Trials 2015; 16:19. [PMID: 25623237 PMCID: PMC4311490 DOI: 10.1186/s13063-014-0529-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 12/19/2014] [Indexed: 11/08/2022] Open
Abstract
Background Breast augmentation with silicone implants is one of the most frequently performed cosmetic surgeries worldwide. Surgical site infection (SSI) remains an important complication of this procedure. One of the most important risk factors for SSI is the presence of microorganisms on the skin surrounding the wound. Guidelines by the Centers for Disease Control (CDC) recommend that surgical wounds be covered with a sterile dressing for 24 to 48 hours. However, a recent study showed that the application of a dressing for six days after breast reduction reduced wound colonization by coagulase-negative staphylococci. Methods/Design A randomized clinical trial was designed to assess two protocols of postoperative wound care to determine how the application duration of the postoperative dressing influences wound colonization in patients undergoing breast augmentation with silicone implants. Women aged between 18 and 60 years who are candidates for breast augmentation with silicone implants will be randomly allocated to group I (n = 48), in which the dressing will be removed on the first postoperative day, or group II (n = 48), in which the dressing will be removed on the sixth postoperative day. Cutaneous colonization will be assessed by cultures of samples of skin flora taken from the wound region. The incidence of SSI, using standardized CDC criteria, and the perceptions of patients towards the dressing will be secondary outcomes. Discussion An important component of SSI prevention is to minimize all possible risk factors, and the application of postoperative dressing plays a key role in this endeavor. The results of this clinical trial may help to standardize postoperative wound care after breast augmentation with silicone implants. Trial registration This trial was registered on 12 March 2012 with ClinicalTrials.gov (identifier: NCT01553604).
Collapse
|
20
|
Empirical treatment of highly suspected nontuberculous mycobacteria infections following aesthetic procedures. Arch Plast Surg 2014; 41:759-67. [PMID: 25396192 PMCID: PMC4228222 DOI: 10.5999/aps.2014.41.6.759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/10/2014] [Accepted: 07/17/2014] [Indexed: 11/13/2022] Open
Abstract
Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.
Collapse
|
21
|
Zhang Y, Dong J, Qiao Y, He J, Wang T, Ma S. Efficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials. Ann Plast Surg 2014; 72:121-30. [PMID: 24343320 DOI: 10.1097/01.sap.0000440955.93769.8c] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is no consensus with regard to antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery. This meta-analysis sought to assess the efficacy and safety of antibiotic prophylaxis and to determine appropriate duration of prophylaxis. METHODS An English language literature search was conducted using PubMed and the Cochrane Collaboration for randomized controlled trials (RCTs) that evaluate the use of antibiotic prophylaxis to prevent postoperative surgical site infection (SSI) in patients undergoing clean and clean-contaminated plastic and reconstructive surgery. Data from intention-to-treat analyses were used where available. For the dichotomous data, results for each study were odds ratio (OR) with 95% confidence interval (CI) and combined for meta-analysis using the Mantel-Haenszel method or the DerSimonian and Laird method. Study quality was critically appraised by 2 reviewers using established criteria. STATA version 12 was used for meta-analyses. RESULTS Twelve RCTs involving 2395 patients were included, of which 8 trials were considered to be of high methodological quality. Effect of antibiotic prophylaxis in plastic and reconstructive surgery was found favorable over placebo in SSI prevention (13 studies; 2449 participants; OR, 0.53; 95% CI, 0.4-0.7; P < 0.01) and the other wound complication (OWC) prevention (9 studies; 1843 participants; OR, 0.36; 95% CI, 0.15-0.84; P < 0.02). Subgroup analysis performed according to surgical wound type or the duration of prophylaxis did not modify the results except for the OWC with short-term antibiotic treatment. Compared with short-term antibiotic prophylaxis, long-term administration showed no evidence of a difference in risk of SSI (7 studies; 1012 participants; OR, 0.99; 95% CI, 0.63-1.55; P < 0.95), OWC (5 studies; 824 participants; OR, 0.92; 95% CI, 0.46-1.86; P < 0.82), and adverse event relative to antibiotic administration (3 studies; 653 participants; OR, 0.23; 95% CI, 0.01-4.92; P < 0.35). CONCLUSIONS This meta-analysis of RCTs provides evidence supporting that antibiotic prophylaxis reduced postoperative SSI in clean plastic surgeries with high-risk factors and clean-contaminated plastic surgeries. Besides, a short-course administration regimen seemed to be of adequate efficacy and safety. High-quality prospective trials on larger scale are needed to further confirm these findings.
Collapse
Affiliation(s)
- Yi Zhang
- From the Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | | | | | |
Collapse
|
22
|
Delaunay F, Pegot A, Coquerel-Beghin D, Aktouf A, Auquit-Auckbur I. Fasciites nécrosantes à Staphylococcus lugdunensis après dermolipectomie abdominale : à propos de deux cas et revue de la littérature. ANN CHIR PLAST ESTH 2014; 59:136-9. [DOI: 10.1016/j.anplas.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
|
23
|
Abstract
INTRODUCTION AND OBJECTIVE We investigated the effects of cefazolin sodium (CS), on wound healing in rats. MATERIAL AND METHOD Forty rats in which an incisional wound model was created by removing two skin strips (4×1 cm), and suturing the wound edges, were included. Four groups were formed in a randomized way with each having 10 rats. The Control group (Group 1) received 1 cc 0·9% NaCl twice daily, whereas Group 2 received single-dose preoperative 30 mg/kg CS, Group 3 received single-dose preoperative 30 mg/kg CS followed by the same dose for three postoperative days, and Group 4 received single-dose preoperative 30 mg/kg CS followed by the same dose for seven postoperative days (via i.p. route). On the first day of the study, as the wound was created, a skin strip of 1×1 cm area was collected for bacteriologic examination. On the third day, specimens were acquired from the incision for histopathologic examination. The rats were sacrificed on the seventh day and more specimens were gained for histopathologic, tensiometric, and bacteriologic tests. RESULT Group 4 demonstrated disrupted normal skin flora; reduced inflammatory cell density, fibroblastic activity, and collagen density; and decreased wound tensile strength. The histopathologic findings with Groups 2 and 3 were as same as with Group 4 and wound tensile strength showed no significant difference compared with the Control group. Group 2 revealed no significant difference compared with the Control group with regard to all parameters. DISCUSSION Seven-day CS therapy had a negative effect on wound healing and changed the normal skin flora.
Collapse
|
24
|
The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients. Arch Plast Surg 2013; 40:522-9. [PMID: 24086804 PMCID: PMC3785584 DOI: 10.5999/aps.2013.40.5.522] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/11/2013] [Accepted: 05/07/2013] [Indexed: 12/02/2022] Open
Abstract
Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.
Collapse
|
25
|
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 705] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Veiga DF, Veiga-Filho J, Damasceno CAV, Sales EML, Morais TB, Almeida WE, Novo NF, Ferreira LM. Dressing wear time after breast reconstruction: study protocol for a randomized controlled trial. Trials 2013; 14:58. [PMID: 23432779 PMCID: PMC3604956 DOI: 10.1186/1745-6215-14-58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 02/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the major risk variables for surgical site infection is wound management. Understanding infection risk factors for breast operations is essential in order to develop infection-prevention strategies and improve surgical outcomes. The aim of this trial is to assess the influence of dressing wear time on surgical site infection rates and skin colonization. Patients' perception at self-assessment will also be analyzed. METHODS/DESIGN This is a two-arm randomized controlled trial. Two hundred breast cancer patients undergoing immediate or delayed breast reconstruction will be prospectively enrolled. Patients will be randomly allocated to group I (dressing removed on postoperative day one) or group II (dressing removed on postoperative day six). Surgical site infections will be defined by standard criteria from the Centers for Disease Control and Prevention (CDC). Skin colonization will be assessed by culture of samples collected at predefined time points. Patients will score dressing wear time with regard to safety, comfort and convenience. DISCUSSION The evidence to support dressing standards for breast surgery wounds is empiric and scarce. CDC recommends protecting, with a sterile dressing for 24 to 48 hours postoperatively, a primarily closed incision, but there is no recommendation to cover this kind of incision beyond 48 hours, or on the appropriate time to shower or bathe with an uncovered incision. The results of the ongoing trial may support standard recommendations regarding dressing wear time after breast reconstruction. TRIAL REGISTRATION ClinicalTrials.gov identifier: http://NCT01148823.
Collapse
Affiliation(s)
- Daniela Francescato Veiga
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
28
|
Toia F, D’Arpa S, Massenti MF, Amodio E, Pirrello R, Moschella F. Perioperative antibiotic prophylaxis in plastic surgery: A prospective study of 1100 adult patients. J Plast Reconstr Aesthet Surg 2012; 65:601-9. [DOI: 10.1016/j.bjps.2011.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/09/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022]
|
29
|
Mirzabeigi MN, Mericli AF, Ortlip T, Tuma GA, Copit SE, Fox JW, Moore JH. Evaluating the role of postoperative prophylactic antibiotics in primary and secondary breast augmentation: a retrospective review. Aesthet Surg J 2012; 32:61-8. [PMID: 22231414 DOI: 10.1177/1090820x11430830] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of postoperative prophylactic antibiotics following augmentation mammaplasty remains a controversial topic, with many surgeons opting for extended prophylaxis. OBJECTIVES The authors evaluate the role of postoperative prophylactic antibiotics in both primary and secondary cosmetic breast augmentation. METHODS A five-year retrospective chart review was performed on all patients undergoing cosmetic breast augmentation at a single institution from January 2005 to December 2009. The four attending physicians in this study utilized similar perioperative protocol and implant materials. Patients were divided into two cohorts: those who had received three days of postoperative antibiotics (primarily cephalosporins) and those who had not. End points of particular interest included infection, capsular contracture (CC), and local wound complications. The mean follow-up time was 3.8 years. RESULTS A total of 605 implants were included over the five-year study period. The overall infection rate was 0.66%. For primary augmentation, 493 implants were studied, with 52% of those patients having received postoperative antibiotics. There was no statistically significant reduction in infection, CC, or total complication rate for those receiving postoperative antibiotics. Similarly, 112 implants were studied for secondary augmentation, and again, postoperative antibiotics were not associated with a reduction in complications. CONCLUSIONS The data suggest that there was no reduction in the overall rate of total complications, infection, or CC with postoperative prophylactic antibiotics for either primary or secondary cosmetic breast augmentation. This study provides Level 3 evidence in support of discontinuing prophylactic postoperative antibiotics following cosmetic breast augmentation.
Collapse
Affiliation(s)
- Michael N Mirzabeigi
- Division of Plastic Surgery, Thomas Jefferson University Hospital, 840 Walnut Street, Philadelphia, PA 19107, USA.
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Improvements in infection prevention practices over the past several decades have enhanced outcomes following aesthetic surgery. However, surgical site infections (SSI) continue to result in increased morbidity, mortality, and cost of care. The true incidence rate of SSI in aesthetic surgery is unknown due to the lack of a national surveillance system, but studies of SSI across surgical specialties have suggested that many of these infections are preventable. Patient-related factors-including obesity, glycemic control, and tobacco use-may contribute to the development of SSI following aesthetic surgery. In terms of SSI prevention, proper handwashing and surgical skin preparation are integral. Furthermore, the administration of prophylactic antibiotics has been shown to reduce SSI following many types of surgical procedures. Unfortunately, there are few large, randomized studies examining the role of prophylactic antibiotics in aesthetic surgery. The authors review the medical literature, discuss the risks of antibiotic overutilization, and detail nonpharmacological methods for reducing the risk of SSI.
Collapse
Affiliation(s)
- Michael A Lane
- Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri, USA.
| | | | | |
Collapse
|
31
|
|
32
|
Postbariatric patients undergoing body-contouring abdominoplasty: two techniques to raise the flap and their influence on postoperative complications. Ann Plast Surg 2009; 62:613-7. [PMID: 19461270 DOI: 10.1097/sap.0b013e3181856d85] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Postbariatric patients undergoing abdominoplasties were retrospectively analyzed to correlate postoperative local complications with the 2 most commonly used techniques of raising the abdominal flap: diathermocoagulation versus scalpel. All patients undergoing body-contouring abdominoplasties were included. Excluded were patients with ongoing clinical infections, those that received a complete course of antibiotic in the 6 months before operation, those requesting steroid therapy, those with systemic diseases that could impair wound repair (arteriosclerosis, diabetes mellitus), and those who had undergone apronectomy. One hundred thirty-seven patients were divided into 2 groups (diathermocoagulation = 90 vs. scalpel = 47). Overall, 7 seromas (5.1%), 7 hematomas (5.1%), and 28 wound infections (20.4%) were detected. A higher occurrence of postoperative hematomas was found after the flap raised using a scalpel (12.8% vs. 1.1%, Fisher exact test, P < 0.05), with a relative risk of 11.6. A significant association existed between postoperative hematomas and wound infections with delayed healing (n = 10, 7.3%): 43% of patients with a hematoma also experienced a wound infection with delayed healing versus 5.4% of those that did not develop hematomas (Fisher exact test; P < 0.01). In patients for whom a scalpel had been used to raise the flap, this correlation persisted (50% of patients with a hematoma had developed a wound infection with delayed healing vs. 7.3% of those that did not develop hematomas; Fisher exact test; P < 0.05).In postbariatric patients, diathermocoagulation reduces the occurrence of postoperative hematomas and wound infections with delayed healing compared with the cold knife.
Collapse
|
33
|
Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16:394-7. [PMID: 18626261 DOI: 10.1097/moo.0b013e32830c1edc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|