Posted on August 30, 2013
We doctors are always trying to make things better. I was reading in the June 2013 issue of Plastic and Reconstructive Surgery Journal an article on “Core Measures: Implications for Plastic Surgery.” Core measures are things recommended by the US Department of Health Joint Commission on Accreditation of Healthcare Organizations. They have measures to reduce the incidence of infections, blood clots, and mortality. What do they look at?
- timing and kind of antibiotics
- temperature of the patient
- catheters
- hair removal
These measures are evidenced based and validated across a diverse groups of specialties, though a few have differing opinions based on plastic surgery evidence and practices.
Some findings which apply to plastic surgery:
- Antibiotics: you should receive a dose of antibiotics within an hour of surgery start time. As for antibiotics after surgery, for plastic surgery there are conflicting studies when looking at antibiotics for implant surgeries like breast augmentations, and for surgeries where you have a drain like tummy tucks. The negative of antibiotics? It can change the kind of bacteria in your body to drug resistant ones, and you can get Clostridium difficile infection.
- To shave or not to shave? The answer is NO. Shaving with a razor has been shown to increase surgical site infection. If you need to be trimmed (like the pubic area for a tummy tuck), we will use electric clippers.
- Catheters. The risk of developing a UTI goes up a lot if catheters stay in past post operative day 2. You need a catheter for certain surgeries and depending on the length of surgery. I don’t like to leave them in for another reason as well- it forces you to get out of bed, which is important after surgery.
- What is your temp? This is not thinking you having a fever. During surgery you are naked. Surgery rooms are kept cool to avoid growth of bacteria. We don’t want you to get cold. We put heating blankets on you and cover you during surgery. If you do get cooler, it has been associated with increased risk of bleeding and surgery site infections.
- Blood Clots. I have discussed this in many prior blogs. Early ambulation and leg compression devices during surgery are used with every patient (for me). If you have a higher risk, low molecular weight heparin may also be used. There are considerations with this in plastic surgery due to risk of bleeding issues.