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Evaluation of Antibiotic Prophylaxis in RhinoplastyA Systematic Review and Meta-analysis

Educational Objective
To understand the evidence for the use of postoperative antibiotic prophylaxis in rhinoplasty
1 Credit CME
Key Points

Question  What is the evidence from randomized clinical trials on effectiveness and appropriate administration of antibiotics in rhinoplasty procedures?

Findings  In a systematic review and meta-analysis, a pooled study sample of 589 participants were extracted from 5 randomized clinical trials. Postoperative antibiotic therapy did not significantly alter the rate of infections after rhinoplasty procedures.

Meanings  Based on these findings, preventive antibiotic therapy in rhinoplasty does not appear to be indicated.

Abstract

Importance  Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.

Objective  To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.

Data Sources  MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.

Study Selection  Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.

Data Extraction and Synthesis  Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.

Main Outcomes and Measures  Difference in infectious complication rate between groups.

Results  A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86).

Conclusions and Relevance  This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study’s results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.

Level of Evidence  1.

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Article Information

Accepted for Publication: July 14, 2018.

Corresponding Author: Sam P. Most, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA 94305 (smost@stanford.edu).

Published Online: November 29, 2018. doi:10.1001/jamafacial.2018.1187

Author Contributions: Drs Most and Saltychev had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Nuyen, Kandathil, Laimi, Saltychev.

Drafting of the manuscript: Nuyen, Kandathil, Saltychev.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Saltychev.

Administrative, technical, or material support: Nuyen, Kandathil, Rudy, Most.

Supervision: Kandathil, Laimi, Most, Saltychev.

Conflict of Interest Disclosures: None reported.

Meeting Presentation: This work was presented as a podium presentation for the 12th International Symposium of the American Academy of Facial Plastic and Reconstructive Surgery; October 15-18, 2018; Dallas, Texas.

Disclaimer: Dr Most is an Associate Editor of JAMA Facial Plastic Surgery but was not involved in any of the decisions regarding review of the manuscript or its acceptance.

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