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Although prophylactic antibiotic use following autologous breast reconstruction post-mastectomy is a common practice, there is no consensus in the literature regarding its duration. Antibiotic stewardship is important to minimise multi-resistant organisms as well as mitigate the associated side effects. Currently, there are no published guidelines regarding the duration of prophylactic antibiotics in autologous breast reconstruction surgery following mastectomy. The authors searched the online literature regarding the administration of antibiotics for autologous breast reconstruction surgery post-mastectomy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The primary outcome measure was the incidence of surgical site infections (SSIs). Three studies met the inclusion criteria and included a total of 1,400 patients. Overall, 101 (7.2%) SSIs were observed. There was no significant difference in the rate of SSIs when comparing the use of antibiotics for less than or longer than 24 hours postoperatively (odds ratio = 1.434, p = 0.124). There is no significant difference between SSIs with the use of antibiotics for longer than 24 hours when compared to less than 24 hours. Further studies in the form of randomised controlled trials are required to assess the effects of prophylactic antibiotic duration in autologous breast reconstruction following mastectomy.
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Background Femoral neck fractures are common injuries. Although many studies have compared two-hole dynamic hip screw (DHS) versus multiple cannulated cancellous screw (CCS) fixation for undisplaced intracapsular fractured neck of femurs (NOF), there is no consensus on which surgical technique results in better outcomes. The aim of our study was to compare DHS and CCS for undisplaced NOFs. The primary outcomes were reoperation and mortality rates at one year postoperatively. Methodology A retrospective analysis was performed involving all patients who underwent fixation with DHS/CCS for an undisplaced intracapsular NOF at our hospital between January 2016 and December 2020. All patients had a minimum follow-up time greater than one year. All patients underwent a standardised NOF protocol. Patients either underwent DHS or CCS fixation according to surgeon preference, and there was no randomisation to either group. Results A total of 41 patients underwent fixation with DHS compared to 32 who underwent CCS. The reoperation rate at one year was 9.8% in the DHS group compared to 6.3% in the CCS group. This difference was not statistically significant (p = 0.588). The one-year mortality rate was similar between groups at 22.0% and 21.9% in the DHS group and the CCS group, respectively (p = 0.994). Registrar-level surgeons performed 80.5% of DHS compared to 59.4% of CCS, and consultant surgeons performed 4.9% of DHS compared to 25% of CCS. Conclusions There was no significant difference in revision rates or complications seen between CCS and DHS. A significantly higher percentage of CCS fixations were performed by consultant-grade surgeons at our hospital compared to DHS. This study provides further data on the choice of fixation method for intracapsular fractures. It also reports on the grade of the operating surgeon at our unit, which may be a factor in the quality of fixation and ultimately reoperation rates.
RESUMEN
INTRODUCTION: Rib fractures are a common presentation in both patients presenting with high impact poly-trauma and as a result of low energy falls in the elderly. This injury can lead to various complications including prolonged hospital admission, pneumonia, need for ventilation and in admission to intensive care unit. There is much controversy around the management of this injury in the literature, with favourable outcomes for patients treated non-operatively as well as surgically. METHODS: We collated a database for all rib fracture fixations between 2014 and 2019 that took place at the major trauma centre in Liverpool. The decision to undergo surgical fixation was after discussion with multidisciplinary team at trauma meeting. Following British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASTs), these injuries should ideally be operated on within 48 h. RESULTS: Overall, a total of 220 patients were included in the study (143 male and 77 female). 142 (64%) patients were operated on within 48 h of admission. A total of 101 (45%) patients required admission to ITU. Those in the early surgical fixation group had a statistically significant decrease in their hospital length of stay (12.8 days compared to 15.5 days, p=<0.001). Mean length of ITU stay was shorter in the early surgical group with no statistical significance (p = 0.1). Those patients that required mechanical ventilation in turn stayed in hospital for a longer period compared to those who did not (p=<0.001). There is no statistical difference in survival between the 2 patient groups (p = 0.3). DISCUSSION: To our knowledge, this is the largest data set published in the rib fracture fixation cohort. Our results agree with previous studies which have demonstrated that those who undergo ORIF tend require fewer days of hospital stay, less ventilatory support and overall have better outcomes in terms of pain when compared to those treated non-operatively. Our study adds that patients who receive treatment within 48-hours as per BOAST guidelines have better outcomes, specifically reducing hospital length of stay by nearly 4 days (p = 0.014). CONCLUSION: Early surgical fixation of rib fractures leads to significantly favoured outcomes.