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The Role of Hydroxyethyl Starch in Preventing Surgical-Site Infections and Nipple Necrosis in Patients Undergoing Reduction Mammaplasty: A Prospective Case–Control Study of 334 Patients

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Abstract

Background

Surgical-site infections after reduction mammaplasty are associated with poor cosmetic results. This study investigated the postoperative antiinflammatory influence of hydroxyethyl starch and its effect on surgical-site infections after breast reduction.

Methods

In this prospective case–control study, 334 patients undergoing reduction mammaplasty were prospectively assigned in a 2:1 ratio to receive either 2 × 250 ml of hydroxyethyl starch 6 % or saline solution 0.9 % for 3 days postoperatively. Patient follow-up evaluation was at least 1 month. Using uni- and multivariate analyses, this study aimed to identify risk factors for surgical-site infections and nipple necrosis.

Results

Surgical-site infections occurred in 6.6 % of the hydroxyethyl starch group and in 3.6 % of the control group (p = 0.704). Hydroxyethyl starch had no effect of reducing surgical-site infections [p = 0.212; odds ratio (OR), 0.317; confidence interval (CI), 0.052–1.925]. According to univariate analyses, hydroxyethyl starch reduced the occurrence of postoperative fever (p = 0.085; OR 0.608; CI 0.345–1.072), and fever was associated with increased infection rates (p = 0.033; OR 2.335; CI 1.071–5.089). Additional risk factors for postoperative infections were diabetes (p = 0.051; OR 4.051; CI 0.997–16.463) and obesity (normal weight vs grade ≥2: p = 0.003; OR 7.612; CI 2.031–28.529). Multivariate analysis showed no independent predictors for surgical-site infections. Nipple necrosis were equally observed in the two groups (p = 0.458; OR 1.643; CI 0.443–6.097).

Conclusion

The antiinflammatory approach of hydroxyethyl starch did not lead to a decrease in infections or nipple necrosis. No difference in surgical-site infections was observed between aesthetic and oncologic procedures.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Acknowledgments

The authors thank Peter Koerfgen for English proofreading. All costs were handled by the hospital and the authors themselves. No funding from third parties was received.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Breast Unit, University of Rostock, Suedring 81, 18059, Rostock, Germany

    Max Dieterich, Toralf Reimer, Johannes Stubert & Bernd Gerber

  2. Institute for Biostatistics and Informatics in Medicine, University of Rostock, Ernst-Heydemann-Str. 8, 18057, Rostock, Germany

    Guenther Kundt

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Correspondence to Max Dieterich.

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Dieterich, M., Reimer, T., Kundt, G. et al. The Role of Hydroxyethyl Starch in Preventing Surgical-Site Infections and Nipple Necrosis in Patients Undergoing Reduction Mammaplasty: A Prospective Case–Control Study of 334 Patients. Aesth Plast Surg 37, 554–560 (2013). https://doi.org/10.1007/s00266-013-0113-5

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