Prophylactic postop antibiotics not recommended for orbital surgery

This retrospective study of patients undergoing enucleation or ocular evisceration found that prophylactic postoperative antibiotics do not appear to lower the risk of postoperative infection.

The authors recommend that surgeons follow their patients closely and reserve antibiotics until signs of infection arise, since a new infection can be treated effectively when signs or symptoms first appear.

The study included 644 evisceration or enucleation surgeries conducted at four institutions between 1996 and 2011. All patients received a single, perioperative, intravenous dose of antibiotics, 90 percent of patients received an orbital implant, and 59 percent received postoperative antibiotics.

While patients with infectious indications for surgery were more likely to receive postoperative antibiotics (P < 0.001), the difference in the postoperative infection rate between patients who received postop antibiotics and those that did not was not statistically significant. Also no patients with infectious indications for surgery who did not receive postoperative antibiotics developed a postoperative infection.

These results demonstrate the clinical safety of withholding postoperative prophylactic antibiotics in orbital surgery, even when implanting alloplastic material in a sterile field. The authors note that the Centers for Disease Control and Prevention mandates cessation of postop antibiotics within 24 hours of surgery. They caution surgeons not to generalize these results to nonsterile surgery, such as sinonasal or naslacrimal surgery.