Comparison Of Single-Dose And Multi-Dose Antibiotic Prophylaxis In Orthognathic Surgery: A Retrospective Cohort Study

Abstract

Objective: (1) to compare the prophylactic effect of a single versus a multiple dose antibiotic regimens and (2) to determine factors related to surgical site infection in orthognathic surgery. Materials and methods: Medical records of patients underwent orthognathic surgery in the Faculty of Dentistry, Chulalongkorn University between 2014 and 2016 were extracted for medical data including demographic data, American Society of Anesthesiologists (ASA)-classified past medical history, orthognathic surgical procedures and complications, prophylactic antibiotic regimen, and surgical site infection. The records also contained 30-day follow-up information, according to the Centers for Disease Control and Prevention (CDC) diagnostic criteria for surgical site infection. Results: Of 168 patients, three developed signs of infection and four presented maxillary sinusitis. In the infected group, one received 1.2g single-dose intravenous amoxicillin-clavulanate at induction while the remaining two patients were administered with 2 million units intravenous penicillin G every 4 hours perioperatively and one out of two received 1g oral amoxicillin twice a day for a week postoperatively. No significant association was found between types of antibiotic prophylaxis and surgical site infection (p = 0.472). Prolonged operation time significantly increased the risk of infection (p = 0.030). There was no significant difference in infection among other factors including age, gender, ASA score, smoking behavior, orthognathic surgical operations, blood loss, blood transfusion, bone grafting and bad split. Moreover, there was no significant association between contributing factors related to surgical site infection and postoperative maxillary sinusitis. Conclusion: The results suggest that the single-dose antibiotic prophylaxis can be sufficient in prevention of surgical site infection. Prolonged operation time increases the risk of infection.