Nuyen B, et al. - For the first time, in a Cochrane-protocol systematic review and meta-analysis, the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty was examined. Pooled evidence from 5 randomized clinical trials (RCTs) revealed that using postoperative antibiotic therapy confer no significant alteration in the rate of infections after rhinoplasty procedures.

Methods

• With prospectively designed search phrases, researchers searched MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science on February 16, 2018.
• They searched all databases from database inception.
• Rhinoplasty, nasal valve repair, and antibacterial agent were the key search terms.
• Selection criteria comprised 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.
• They performed classification of the interventions of interest into 3 types:
• Single-dose systemic antibiotic administered within 24 hours before the first incision,
• Multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and
• Systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision.
• They made the following comparisons: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.
• Based on the PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions, they performed the data extraction.
• The relevance of the remaining records at abstract and full-text stages were assessed by two independent reviewers.
• Using random-effects model pooling of meta-analysis was done.
• Groups were compared regarding difference in infectious complication rate.

Results

• Researchers identified a total of 262 records; predetermined population, intervention, comparison, and outcome criteria were fulfilled by only 5 RCTs among these records.
• Five hundred and eighty nine participants formed the pooled study sample.
• They noted no relevant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P=.86).