Antibiotic prophylaxis and surgical site infections in orthognathic surgery – a retrospective analysis

(2023) 23:688 Naros et al. BMC Oral Health https://doi.org/10.1186/s12903-023-03391-3 BMC Oral Health Open Access RESEARCH ARTICLE Antibiotic prophylaxis and surgical site infections in orthognathic surgery – a retrospective analysis Andreas Naros1, Carola Helene Naros1, Daniel Awad1, Michael Krimmel1 and Susanne Kluba1* Abstract Background This study was conducted to determine surgical site infection (SSI) rates and potential risk factors as well as to evaluate antibiotic prophylaxis in orthognathic surgery. Methods This retrospective observational study included patients who received orthognathic surgery. SSIs and their management were assessed for up to one year post-operatively. The applied antibiotic regime and other possible influencing factors (smoking, age, site of infection, drainage, duration of surgery, displacement distances, craniofacial malformations) were assessed. Results In total 291 patient met the inclusion criteria (56.7% female). The mean age at surgery was 25.5 ± 8.5 years. Fifty-four patients (18.6%) were diagnosed with a craniofacial malformation. Relevant previous surgeries were documented in about one quarter of included patients (n = 75). Ninety-two percent of patients (n = 267) received intraoperative single-dose antibiotic prophylaxis. Surgical site infections occurred in 12.4% (n = 36) of patients. There was a significant association between postoperative infections and type of surgery (P = .037) as well as type of drainage (P = .002). Statistical analyses also revealed a higher prevalence of smokers (P = .036) and previous surgically assisted rapid palatal expansion (SARPE) (P = .018) in the infection group. Furthermore, no significant relationships were observed between postoperative infections and various co-factors (i.e. antibiotic regime, age at surgery, gender, associated craniofacial malformations, surgery duration, displacement distances, mandibular setback vs. advancement). Conclusion Low rates of SSIs occurred following an intraoperative single-dose antibiotic regime. None of the SSIs had a significant effect on the final surgical outcome. Present data do not warrant escalation of the antibiotic regimen. Postoperative smoking and capillary drainage should be avoided. Keywords Orthognathic surgery, Surgical site infection, Antibiotics *Correspondence: Susanne Kluba 1 Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Osianderstrasse 2‑8, Tuebingen 72076, Germany Background Orthognathic surgery is a frequently performed elective maxillofacial procedure to correct skeletal dentofacial anomalies. The intervention is classified as a clean-contaminated class II-surgery [1] and surgical site infections (SSI) are a relevant problem. The data on infection rates vary enormously, from 1.4% to 33.4% [2, 3]. SSIs endanger the surgical outcome and represent a significant additional burden for the patient and the health care provider. © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Naros et al. BMC Oral Health (2023) 23:688 Therefore, reducing the risk of infection is a high priority in treatment and has always been the subject of much scientific research. Various prophylactic measures have been established, among which antibiotic prophylaxis is discussed particularly frequent and controversially. The alarming facts from the WHO [4] on the development of resistance and the associated predictions on mortality underline the need to critically evaluate any application. To date, the antibiotic prophylaxis regimes applied have been very heterogeneous, ranging from single-dose pre-/ intraoperatively [5, 6] to perioperative short-term application [7, 8] and administration over several days [9, 10]. The scientific results are very heterogeneous and a consensus or a proven, clearly superior strategy is still not apparent [11, 12]. The published studies differ much in their results and lead to contradictory recommendations. This shows that the correlations are not yet clear and suggests that the factors influencing the infection rates are diverse and that the type and length of antibiotic prophylaxis may be perhaps less decisive than assumed. Thus, despite the numerous published studies, further research on this topic is still important. The wide range of results in the rate of SSI in orthognathic surgery and the ongoing controversial debate on the necessity of a prolonged antibiotic prophylaxis in order to reduce SSI in highly elective procedures encouraged us to conduct this study. Another point were the possible adverse effects of a prolonged application of antibiotics on the individual and on society. A large double-blind study with 14 participating centers, initiated by Ristow et al. [13], in 2021, is intended to bring more clarity. In preparation for participation in this trial. The purpose of the present study was therefore to add further clinical results to the existing data in literature. We aimed to retrospectively determine the SSI rates for these interventions in our series and to discuss antibiotic prophylaxis, but also to detect other possible influencing factors in addition to the antibiotic prophylaxis regime. The null hypothesis was, that a prolonged antibiotic prophylaxis regime has no influence on the rate of SSI in orthognathic surgery. Material and methods Study design and data collection Our electronic database was searched for patients with dentofacial anomalies and malocclusions who underwent orthognathic surgery in our department between 2010 and 2020. We only included patients with complete clinical and radiological documentation as well as patients who received one-jaw (bilateral sagittal split osteotomy (BSSO) or Le Fort I-osteotomy) or bimaxillary, two-jaw surgery (BSSO and Le Fort I). The Page 2 of 8 exclusion criteria were patients with incomplete documentation as well as patients who received surgically assisted rapid palatal expansion (SARPE), Le Fort II or Le Fo (...truncated)