Evaluation of Postoperative Infection Rates in 3084 Rhinoplasty Cases Using Antibiotic Soaks and/or Irrigations

Overview

Infections after rhinoplasty are rare but damaging, with published rates below 2 percent and higher figures in revision surgery. This retrospective chart review covered the primary author's rhinoplasty patients from 2002 to 2019. The stated objectives were to describe the use of antibiotic soaks and irrigations during surgery and to evaluate the resulting infection rates.

Sections of note

• Retrospective chart review of 3,084 rhinoplasty procedures, single surgeon, 2002 to 2019.
• There were 19 postoperative infections overall, a rate of 0.62 percent.
• Patients without antibiotic soaks or irrigations had 17 infections, a rate of 1.01 percent.
• The infection rate with antibiotic soaks was 0.08 percent, a significant reduction against no soaks or irrigations, P equals 0.0053.
• With both soaks and irrigations there was 1 infection, a rate of 0.49 percent, not significantly different from either no treatment or soaks alone.
• Antibiotic soaks reduced infections particularly in secondary rhinoplasty.
• The authors describe soaks and irrigations as safe, effective and well tolerated.
• They suggest considering them for patients with extensive revision history, trauma, filler, prior infection or underlying disease.

What it means for a patient

• Soaking grafts and implants in antibiotic solution before placing them was associated with a twelvefold lower infection rate in this series.
• Adding irrigation on top of soaking showed no additional benefit in these numbers.
• This is a retrospective single surgeon comparison across 17 years, not a randomized trial, so practice changed over time alongside the technique.
• Nineteen infections in total is a small number of events on which to base rate comparisons.

Why this paper matters

Infection after rhinoplasty can destroy grafts and require reconstruction, and prevention practices vary widely between surgeons. This is one of the largest single practice datasets on the question. Whether soaking causes the lower rate, rather than accompanying other changes, remains unproven.

Terms

• Antibiotic soak: immersing grafts or implants in antibiotic solution before placing them.
• Irrigation: flushing the surgical site with antibiotic solution.
• Infection rate: the proportion of procedures followed by an infection.
• Secondary rhinoplasty: surgery on a nose that has already been operated on.
• Retrospective chart review: analysis of existing medical records after treatment.