Are More Medically Complex Patients Who Undergo Complex Septorhinoplasty at an Increased Risk for Surgical Site Infection?

Background: Prophylactic antibiotics are routinely prescribed by surgeons for their patients who undergo septorhinoplasty. However, the literature to support this remains controversial, especially in complex cases, those that require grafts, revision cases, extended surgical time, and an American Society of Anesthesiologists (ASA) value greater than or equal to 3.

Purpose: The study purpose was to evaluate for a potential association between increased anesthetic complexity and the risk for surgical site infection (SSI) following complex septorhinoplasty.

Study design, setting, sample: Retrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Dallas Veterans Affairs Medical Center. Patients were excluded if they did receive a septorhinoplasty, did not follow up, or had insufficient records.

Independent variable: All patients were assigned an ASA value prior to surgery, with an ASA value of 3 serving as this study's independent variable.

Main outcome variable: The main outcome variable of interest was the development of a postoperative SSI, defined as findings consistent with cellulitis, purulence, or fistula development necessitating antibiotic treatment.

Covariates: The demographic covariates included patient age and sex. Clinical covariates included diabetes status, history of nasal trauma or surgery, and smoking status. The operative covariates were surgical duration, perioperative antibiotic, intraoperative complication, and type of cartilage graft used.

Analyses: χ² Analysis and t-tests were used for calculations, with P values < .05 being considered significant.

Results: A total of 182 patients were included in this study, 81 (45%) with an ASA ≤2 and 101 (55%) with an ASA of 3. A patient's age (P < .01), male sex (P < .01), and a diagnosis of diabetes (P < .01) were associated with an ASA value of 3. In total, there were 6 (3.3%) SSIs, with 2 (1%) occurring in those with an ASA of 3. An ASA value of 3 (P = .27, relative risk of .40) was not shown to be associated with an increased risk of SSI.

Conclusion and relevance: Our results suggest that an ASA of 3 is not significant with regard to postoperative infection in patients who undergo a complex nasal septorhinoplasty, and prophylactic postoperative antibiotics are not warranted.