Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence
Hassan ElHawary, Matthew A Hintermayer, Peter Alam, Vanessa C. Brunetti, Jeffrey E. Janis
Abstract
BACKGROUND: Although many interventions are implemented to prevent surgical site infections (SSIs) in plastic surgery, their supporting evidence is inconsistent. OBJECTIVES: The goal of this study was to assess the efficacy of methods for decreasing SSIs in plastic surgery. METHODS: A systematic review and meta-analysis were performed to compare the effects of SSI prevention methods. All the studies were assessed for quality of evidence according to the GRADE assessment. RESULTS: Fifty Level 1 randomized controlled trials were included. The most common interventions for preventing SSIs were antibiotic prophylaxis, showering, prepping, draping, and the use of dressings. Current evidence suggests that antibiotic prophylaxis is largely unnecessary and overused in many plastic surgical procedures, with the exception of head and neck oncologic, oral craniofacial, and traumatic hand surgeries. CONCLUSIONS: Efficacy of antibiotic prophylaxis in plastic surgery is dependent on surgery type. There is a lack evidence that showering and prepping with chlorohexidine and povidone reduces SSIs.