A Prospective Trial on the Use of Antibiotics in Hand Surgery

Abstract

The authors do not support the use of antibiotic prophylaxis for surgery of the hand. Its use should be preserved for specific infections or for patients with certain types of risk factors for infection.

Assessing the Impact of Antibiotic Prophylaxis in Outpatient Elective Hand Surgery: A Single-Center, Retrospective Review of 8,850 Cases

“…Similar to Aydin and colleagues, 22 our study does not support an effective role for antimicrobial prophylaxis in elective hand surgery with operative times greater than 2 hours. However, owing to the limited number of patients with longer operative times, we can neither recommend nor discourage use of prophylaxis with longer operative periods.…”

Meta-analysis of antibiotics for simple hand injuries requiring surgery

“…Six Infected wound (class IV), typical of those excluded from this analysis. This appearance is suggestive of tenosynovitis, usually treated with urgent surgical washout, antibiotics and elevation studies 14,15,17,19,20,26 gave a cephalosporin, four 16,18,22,25 penicillin (flucloxacillin or co-amoxiclav) and three 21,23,24 included any antibiotic prescribed. The trials were statistically homogeneous (P = 0⋅77, χ 2 test, I 2 = 0 per cent), but a random-effects model was used owing to the heterogeneity of regimens.…”

“…Among the RCTs, the risk of bias was low in two relatively recent trials 17,25 , high in two trials 15,16 , and one older trial 26 did not describe its study design in sufficient detail to assess some forms of bias. All five prospective trials were at high risk of bias in at least one area, mostly owing to lack of blinding.…”

“…Additional records identified through other sources n = 12 14 Aydın et al 15 Beesley et al 16 Berwald et al 17 Cassell and Ion 18 Grossman et al 19 Haughey et al 20 Platt and Page 21 Roberts and Teddy 22 Roodsari et al 23 Stone and Davidson 24 Whittaker et al 25 Worlock et al 26 Total Heterogeneity: τ 2 = 0·00; χ 2 = 8·16, 12 d.f., P = 0·77; I 2 = 0% Test for overall effect: Z = 0·69, P = 0·49 …”

Complications Within 30 Days of Hand Surgery: An Analysis of 10,646 Patients

“…In a randomized controlled trial of preoperative antibiotics versus placebo in 1,340 hand surgery patients, the incidence of surgical-site infection was 3.2% (AE 0.6%). 22 The majority of these patients underwent emergent procedures. The authors found no significant difference in infection incidence between antibiotics and placebo.…”