Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis

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.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. PRISMA Flow Diagram

Databases accessed using relevant search clauses yielded 262 studies after excluding duplicates and other studies that did not meet criteria. Using the population, intervention, comparison, and outcome framework, 23 records were screened based on full texts and 5 randomized clinical trials were deemed eligible for inclusion in the meta-analyses. PICO indicates population, intervention, comparison of control, and outcome.

Figure 2.. The Pooled Risk Ratio (RR) of Infection When Comparing Postoperative Antibiotics With Placebo or No Treatment and Preoperative or Perioperative Antibiotics

The pooled RR was 0.92 (95% CI, 0.35-2.43; P = .86) with low random effects heterogeneity (I2), 44%.

Figure 3.. The Pooled Risk Ratio (RR) of Infection When Comparing Postoperative Antibiotics With Placebo or No Treatment (Excluding Preoperative or Perioperative Antibiotics)

The pooled RR was 0.43 (95% CI, 0.18-1.04; P = .06) with random effects heterogeneity (I2), 0%.