Postoperative Prophylactic Antibiotics Duration and the Rate of Postoperative Complications in Le Fort I Osteotomy Patients

Statement of problem: Orthognathic surgery is considered a “clean-contaminated” procedure since the incisions are made in a field that contains oral bacteria.  Therefore, postoperative antibiotic therapy is commonly recommended to minimize the risk of wound infection.  Lefort I osteotomy procedures expose the wound to additional bacteria when surgical cuts are made through the maxillary sinus.  Accordingly, some surgeons prefer to prescribe extended courses of postoperative antibiotics when a Lefort I osteotomy is part of the surgery. However, there is very little data regarding the surgical outcomes of prolonged antibiotic courses.  We chose to evaluate whether the duration of postoperative prophylactic antibiotics (1 week vs 3 weeks) prescribed to post-Lefort I osteotomy patients has any correlation with the rate of postoperative infections or complications.

Materials and methods: We retrospectively identified 124 patients who had undergone a Lefort I osteotomy alone or a Lefort I combined with a bilateral sagittal split osteotomy at the Oral and Maxillofacial Surgery Department at the University of Pennsylvania from January 2013 to December 2014.  Their charts were reviewed for demographic data, antibiotic duration, and postoperative complications that occurred over a period of 3 months.  The primary outcome was the presence or absence of postoperative infection.  Secondary outcome was a composite variable of all other complications which consist of wound dehiscence, gastrointestinal complications, yeast infections, allergic reactions, need for hardware removal, and presence of sinus pathology.

Methods of data analysis:  Statistical analyses were performed with the JMP software.  Categorical data were compared using the Pearson chi-squared analysis and continuous data were compared with Wilcoxon t-test analysis.  A p-value of less than 0.05 was considered statistically significant.

Results and outcomes data: Of the 124 patients, 74 patients received 1 week of postoperative antibiotics and 50 patients received 3 weeks of postoperative antibiotics.  The patients were followed for an average of 2.2 months.  2 out of 74 patients (2.7%) in the 1-week group developed infection whereas 1 out of 50 patients (2%) in the 3-week group developed infection, which was not statistically significant (p=0.8).  All three infections occurred in the mandible.  Also, 5 out of 74 patients (6.8%) in the 1-week group developed other complications, whereas 6 out of 50 patients (12%) in the 3-weeks group developed other complications, which was also not statistically significant (p=0.32).  Analysis of outcomes within the 1-week group found that there was a higher rate of infection in the double jaw versus the single jaw procedures (7.14% vs 0%, p = 0.04).  However, there was no difference between the two procedures in the 3-week group (4.55% vs 0%, p = 0.19).

Conclusions: There was no statistically significant difference in the rate of postoperative infection or other complications between the two antibiotic duration groups, suggesting that long-term postoperative prophylactic antibiotic therapy after Lefort-I osteotomy may not be necessary.  Interestingly, double jaw procedures seemed to carry a higher rate of infection than single jaw procedures in the 1-week antibiotic group, with all of the infections located in the mandible.  Further studies are required to confirm these findings. 

References:

Tan SK, Lo J, Zwahlen RA. Perioperative antibiotic prophylaxis in orthognathic surgery: a systematic review and meta-analysis of clinical trials. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2011;112(1):19–27.

Danda AK, Wahab A, Narayanan V, Siddareddi A. Single-dose versus single-day antibiotic prophylaxis for orthognathic surgery: a prospective, randomized, double-blind clinical study. Journal of Oral and Maxillofacial Surgery. 2010;68(2):344–6.