Orthognathic surgery for the correction of dentofacial and craniofacial deformities has increased in recent decades and the percentage of patients developing surgical site infection (SSI) is reported to be about 7%.

The aim of this review was to assess the effects of antibiotic prophylaxis for preventing SSI in people undergoing orthognathic surgery.

Methods

Searches were conducted in The Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINHAL, Current Controlled Trials, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and EU Clinical Trials Register databases. There were no language or date restrictions.

Two reviewers independently selected studies and randomised controlled trials (RCTs) involving people undergoing orthognathic surgery comparing one regimen of antibiotic prophylaxis with any other regimen or placebo were considered. The primary outcome was SSI. Secondary outcomes were systemic infections, adverse events, duration of hospital stay and health-related quality of life. Risk of bias was assessed with the Cochrane risk of bias tool. Antibiotic regimens were classified as preoperative (one dose before surgery), short-term (before or during surgery and/or during the same day of surgery) and long-term (before or during surgery and longer than one day after surgery) antibiotic prophylaxis Analysis was conducted using standard Cochrane protocols.

Results

• 11 studies were included.
• 7 trials (472 patients- moderate-quality evidence) provided evidence for the main comparison and overall long-term antibiotic prophylaxis probably reduces the risk of SSI; Risk ratio (RR) = 0.42, 95% confidence interval (CI); 0.24 to 0.74.
• 2 trials (220 patients- low quality evidence) compared effects of short-term antibiotics with a single dose and while those receiving short-term antibiotic prophylaxis were less likely to develop an SSI the result is uncertain RR 0.34, 95%CI; 0.09 to 1.22.
• No reports described adverse effects associated with the drugs in those trials that reported in this outcome.
• None of thetrials assessed or reported data regarding other outcomes, and information was insufficient to show whether a specific antibiotic is better than another.

Conclusions

The authors concluded

For people undergoing orthognathic surgery, long term antibiotic prophylaxis decreases the risk of SSI compared with short-term antibiotic prophylaxis and the is uncertainty of whether short-term antibiotic prophylaxis decreases SSI risk relative to a single pre-operative dose of prophylactic antibiotics.

Commentary

This review suggests that overall long-term antibiotics decrease the risk of SSI in orthognathic surgery compared with short-term regimens. However the quality of the available evidence was downgraded because of concerns over risk of bias in the studies. There were a limited number of studies to compare short-term and single dose regimens and also a variation in the duration of the long-term regimens used. So there is still a need high quality RCTs to identify the best antibiotic regimen and to consider other outcomes such as systemic infection, duration of hospital stay and quality of life as the only benefit that was identified was for SSI.   Three other systematic reviews of this topic have been published (Dental Elf -17^th Mar- 2014) the findings being similar to this new Cochrane review.

Links

Brignardello-Petersen R, Carrasco-Labra A, Araya I, Yanine N, Cordova Jara L, Villanueva J. Antibiotic prophylaxis for preventing infectious complications in orthognathic surgery. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD010266. DOI: 10.1002/14651858.CD010266.pub2.

Dental Elf -17^th Mar- 2014 – Limited evidence for best antibiotic regimens to prevent postoperative infections after orthognathic surgery