Antibiotics in Septorhinoplasty: Routine Necessity or Unnecessary Precaution? A Nationwide Propensity-Score Matched Retrospective Cohort Study.

[BACKGROUND] The nasal cavity's natural bacterial flora poses a risk for postoperative infections, prompting surgeons to administer prophylactic antibiotics during septorhinoplasty. However, this practice's effectiveness is debated due to concerns about antibiotic resistance and variability in practice. This study leverages a large nationwide database to evaluate the impact of perioperative antibiotics on infection, cellulitis, and sepsis rates following septorhinoplasty.

[METHODS] A retrospective cohort study was conducted to identify patients undergoing septorhinoplasty using the TriNetX network, querying 133 million US medical records over 20 years. Outcomes up to three months post-surgery were compared between those administered antibiotics within one day before or on the day of surgery and those that were not. Antibiotics included cefazolin, amoxicillin, clindamycin, azithromycin, clarithromycin, and cephalexin. Propensity score matching was performed on demographics, tobacco use, and other immune-related comorbidities (diabetes mellitus, human immunodeficiency virus, systemic lupus erythematosus, rheumatoid arthritis, liver cirrhosis, chronic kidney disease, chronic systemic steroids, and chemotherapy status). Infection, cellulitis, and sepsis risks were compared across cohorts.

[RESULTS] 14,760 septorhinoplasty patients were identified who received perioperative antibiotics, and 4,640 patients that did not. After propensity score matching, 4,086 patients remained in each cohort. There was no significant difference in infection risk (RR 1.110, p = 0.812) or cellulitis (RR 1.180, p = 0.565). No cases of sepsis were reported in either cohort.

[CONCLUSION] Prophylactic antibiotics did not significantly reduce the risk of infection, cellulitis, or sepsis in septorhinoplasty patients. Future research is required to optimize evidence-based guidelines on antibiotic use in elective nasal surgeries.

[LEVEL OF EVIDENCE III] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .