Abstract
Introduction
The current standard of practice in implant-based breast reconstruction is irrigation
of the mastectomy pocket with antimicrobial solution before implant placement. Prior
to being banned and formally recalled in January 2020, bacitracin was a very commonly
utilized antibiotic. This study characterizes the effects of the national bacitracin
ban on implant-based breast reconstruction infection rates by using a nationwide database
to compare complication rates before and after bacitracin was banned.
Materials and Methods
The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP)
database was queried retrospectively for all patients who underwent implant-based
breast reconstruction before the bacitracin ban (2012-2019) and afterwards (2020).
Demographics, comorbidities, and complications were collected. Univariate analysis
and multivariate analysis were conducted to determine if there were significant changes
in wound complications, local wound infections, and systemic infections between the
2 case-control matched cohorts.
Results
A total of 37,126 patients were in the pre-ban cohort and 6333 patients were in the
post-ban cohort. Before matching, there were significant differences in race distribution,
BMI, ASA class, inpatient vs. outpatient status, preoperative smoking, and preoperative
diabetes mellitus (all P < .05). After case-control matching, there were 6313 patients in each cohort. Univariate
analysis revealed differences in postoperative superficial and organ space surgical
site infection, wound complications/infections, all cause complications, and reoperations
(all P < .05). Multivariate analysis showed that patients who underwent breast reconstruction
before the ban had decreased odds of having wound infections, related infections,
all cause complications, and reoperations (all P < .05).
Conclusion
This study provides a macroscopic view into the effects of the formal injectable bacitracin
ban on breast reconstruction outcomes. Patients who underwent implant-based breast
reconstruction after the ban of injectable bacitracin had higher odds of developing
wound infections, related infections, and reoperations. More study into suitable alternatives
to injectable bacitracin for surgical site antimicrobial irrigation is warranted.
Keywords
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Article info
Publication history
Published online: December 29, 2022
Accepted:
December 26,
2022
Received:
October 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
#Submitted to: American Association of Plastic Surgeons 2023 Annual Meeting
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
