This is a common question we get asked by our patients as we all want to avoid any infection with surgery. Although all surgery carries a small risk of wound infection, there is good evidence that antibiotics are not needed after surgery if a dose is given at the time of surgery.
Evidence from the American Society of Plastic Surgeons indicates that continuing prophylactic antibiotics for greater than 24 hours after a surgical procedure has no benefits and can in fact do harm.

Current evidence suggests that discontinuing antibiotic prophylaxis within 24 hours or less after surgery is sufficient in preventing surgical site infection compared to continuing antibiotic prophylaxis beyond 24 hours after surgery. Prolonged use of antibiotics may increase the occurrence of antibiotic resistant bacteria and increase the risk of other infections. This recommendation is also supported by the Surgical Care Improvement Project, which is a national quality partnership of organizations interested in improving surgical care by significantly improving surgical complications. In cases where a surgical drain is placed next to a prosthetic device (breast implant or tissue expander), there is not enough evidence to recommend discontinuing antibiotics and therefore the decision is left to the surgeon’s discretion.

This recommendation does not apply to cardiothoracic surgical procedures.

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The American Society of Plastic Surgeons (ASPS) is composed of more than 94% of all board-certified plastic surgeons in the United States and Canada who perform aesthetic and reconstructive surgery. Representing more than 7,000 member surgeons, the Society is recognized as a leading voice for advancing quality care to plastic surgery patients by encouraging high standards of training, ethics and physician practice and research.

The Choosing Wisely® campaign dovetails with our own commitment to providing quality care to plastic surgery patients and helping them make the most informed decisions about procedures. The Society continuously works to improve evidence-based clinical guidelines, quality measures and quality improvement programs in order to better serve patients and to ensure their surgical goals are met. Our Symbol of Excellence is a promise that an ASPS member surgeon will be board certified in plastic surgery and meets strict requirements for training and ethics, including pre- and post-operative relationships with patients; procedures will be carried out only in accredited medical facilities; surgeons adhere to a strict code of ethics; and fulfills ongoing continuing education requirements, including patient safety techniques. For more information, find us at PlasticSurgery.org

For more information or questions, please visit PlasticSurgery.org.

How this list was created: The Choosing Wisely® initiative was initially reviewed by the American Society of Plastic Surgeons (ASPS) Quality and Performance Measurement Committee and the Executive Committee. Once ASPS signed on to participate in the initiative, ASPS Quality staff solicited potential topic suggestions from the ASPS Health Policy, Patient Safety and Quality and Performance Measurement Committees. All topic suggestions were collected and collated with topics that were suggested by multiple committees or committee members being prioritized. A final list of prioritized topics was developed and compared to those currently included on lists that have been published by other specialty societies, to minimize any overlap. ASPS Quality staff then conducted a review of supporting evidence, including evidence-based clinical practice guidelines and systematic reviews. The draft topics/statements for the ASPS list were then narrowed down further, based on supporting evidence and a final review by the Quality and Performance Measurement Committee. The final suggested list was then shared with the active ASPS membership and approved by the ASPS Executive Committee.

References and Evidence

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery.Am J Health Syst Pharm. 2013 Feb 1;70(3):195–283.

Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004 Jun 15;38(12):1706–15.