Antibiotic Prophylaxis in Elective Hand Surgery

Vasconcelos, Carolina; Serra, Marta; Nogueira, Rúben; Carmo, Leonor do

doi:10.1055/s-0037-1608625

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…A recent study evaluated the association between diabetes mellitus and surgical site infections in 346 patients undergoing clean, elective hand surgical procedures lasting <30 minutes. In this cohort, only 4 patients developed a surgical site infection and only 1 of those patients who developed a surgical site infection had diabetes mellitus, leading the authors to conclude that diabetes did not affect the rate of surgical site infection 58 . Ko et al attempted to address whether preoperative antibiotic prophylaxis reduces surgical site infections in patients with diabetes mellitus undergoing carpal tunnel release.…”

Section: Special Scenarios Host Factorsmentioning

confidence: 86%

The Use of Preoperative Antibiotics in Elective Soft-Tissue Procedures in the Hand

Shapiro

Zhuang

et al. 2019

JBJS Rev

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» The use of preoperative antibiotic prophylaxis is not supported for elective cases of patients undergoing soft-tissue hand procedures that are ≤2 hours in length. » The use of preoperative antibiotic prophylaxis is not supported for patients with diabetes undergoing elective, soft-tissue hand surgical procedures. » There is a paucity of literature evaluating the use of preoperative antibiotic prophylaxis in patients with rheumatoid arthritis, those with cardiac valves, and those taking corticosteroids; because of this, there is no evidence to vary from our general recommendations. Surgical site infections are a major source of morbidity and impose a large economic burden in orthopaedic surgery 1-3. Preoperative antibiotic prophylaxis is commonly used to prevent surgical site infection. Although there is evidentiary support for the use of preoperative antibiotic prophylaxis for many orthopaedic procedures (e.g., open fractures 4-6 , lowerextremity fractures 7-9 , and total joint replacement 10-12), the use of preoperative antibiotic prophylaxis for elective soft-tissue hand surgical procedures is controversial 13,14. For example, current recommendations from the American Association of Plastic Surgeons are to not utilize preoperative antibiotic prophylaxis for clean hand surgical procedures, and current recommendations from the American Academy of Orthopaedic Surgeons are to not utilize preoperative antibiotic prophylaxis for carpal tunnel release 15,16. Despite these recommendations, 2 surveys of hand surgeons reported rates of antibiotic use for carpal tunnel syndrome between 31% and 49% 17,18. Although millions of soft-tissue hand procedures are performed each year 19,20 , the rate of infection is reported to be low, with studies showing infection rates between 0.3% and 1.5% 13,21-25 for elective cases (e.g., carpal tunnel release and trigger finger release). Although the rate of infection for urgent soft-tissue cases is reported to be higher (e.g., 1.1% to 9.8% for lacerations, open fractures, or bite injuries 26-28), this review will focus on elective soft-tissue surgical procedures (e.g., carpal tunnel release, trigger finger release, Dupuytren contracture release). Despite the low rate of infections, complications can be devastating, leading to soft-tissue loss, stiffness, scarring, and amputation 29. Preoperative antibiotic prophylaxis, given to prevent infection, is associated with its own complications,

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Section: Special Scenarios Host Factorsmentioning

confidence: 86%

The Use of Preoperative Antibiotics in Elective Soft-Tissue Procedures in the Hand

Shapiro

Zhuang

et al. 2019

JBJS Rev

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“…Hand. With regards to antibiotic-prophylaxis in hand surgery, Vasconcelos et al 14 study show no difference in SSI incidence after administration of prophylaxis or placebo in clean surgery that lasted less than 30 minutes. The procedures that would not require antibiotic therapy are skin incision, soft tissue excision, suturing, and repairing of tearing of muscle, tendon, and fascia 5 .…”

Section: Clinical Applicationsmentioning

confidence: 96%

Antibiotic Prophylaxis in Plastic Surgery: From Systematic Review to Operative Algorithm

Brambullo¹,

Biffoli²,

Scortecci³

et al. 2022

WJPS

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BACKGROUNDWe aimed to provide a single, viable and user-friendly operative protocol for preoperative antibiotic prophylaxis that meets the needs of all plastic surgery practitioners. METHODSThe research was conducted through the abstract and citation databases of peer-reviewed literature Pubmed® (National Center for Biotechnology Information), Medscape® (General Surgery) and Scopus® (Elsevier), comparing existing data from 2010 to 2020. A separated and dedicated research was accomplished for each of 8 macroareas such as: skin and soft tissue, hand, breast, aesthetics, head and neck, trauma, burns and miscellaneous. RESULTSThe findings for each macroareas included the choice of the antibiotic, the route and timing of administration and the clinical applications. Finally, the review has been condensed in an operative algorithm for antibiotic use to apply in each field of plastic surgery. CONCLUSIONWe could provide plastic surgeon an effective, easy-to-use operative protocol for antibiotic prophylaxis in daily activity.

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“…Vasconselos and colleagues conducted a retrospective review of 346 patients (50 had DM) who underwent clean, elective, outpatient hand surgery. 35 Preoperative antibiotics were given at the discretion of the attending surgeon to 180 (52%) of the total number and to 27 (54%) of the patients with diabetes. There were 4 SSI cases (1% infection rate), and 1 of these was a patient with diabetes.…”

Section: Role Of Prophylactic Antibiotics For Patients With Diabetes ...mentioning

confidence: 99%

“…In a different study, Werner et al reviewed 454 987 Medicare patients in a national administrative database and identified 1466 postoperative infections following open CTR (0.32%). 28 Among the independent positive risk factors identified were male sex, younger age, tobacco use, alcohol use, obesity (body mass index of [30][31][32][33][34][35][36][37][38][39][40], morbid obesity (body mass index: >40), and comorbidities including DM, inflammatory arthritis, peripheral vascular disease, chronic liver disease, chronic lung disease, chronic kidney disease, and depression.…”

Section: Association Between Dm and Ssis Following Hand Surgerymentioning

confidence: 99%

Preoperative A1c and Postoperative Infection in Elective Hand Surgery

Schweitzer

Peterson

2022

Hand (New York, N,Y.)

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Diabetes mellitus affects 10.5% of the US population. Numerous studies have documented increased risk of complications for patients with diabetes after different types of surgery, including hand surgery. By aiming for a preoperative target hemoglobin A1c (A1c), the risk of surgical complications following elective hand surgery may be reduced for patients with diabetes. This literature review was conducted to evaluate the association between diabetes mellitus and surgical site infections and, more specifically, to determine whether there is any association between preoperative A1c level and postoperative infections in hand surgery. The risk for surgical site infections and wound complications appears to be higher for patients with insulin-dependent diabetes mellitus, but not necessarily for patients with noninsulin-dependent diabetes mellitus, when compared with patients without diabetes. The role of prophylactic antibiotics for patients with diabetes undergoing elective hand surgery was also considered. Prophylactic antibiotics have not been shown to be beneficial for healthy patients undergoing clean, elective hand surgery. However, preoperative antibiotics may have a protective role for some patients with poorly controlled hyperglycemia.

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Antibiotic Prophylaxis in Elective Hand Surgery

Cited by 5 publications

References 10 publications

The Use of Preoperative Antibiotics in Elective Soft-Tissue Procedures in the Hand

The Use of Preoperative Antibiotics in Elective Soft-Tissue Procedures in the Hand

Antibiotic Prophylaxis in Plastic Surgery: From Systematic Review to Operative Algorithm

Preoperative A1c and Postoperative Infection in Elective Hand Surgery

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