Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Background:The American Board of Plastic Surgery has been collecting practice data on operative repair of flexor tendon lacerations since 2006, as part of its Continuous Certification program. Methods: Data on operative repair of flexor tendon lacerations from 2006 to 2014 were reviewed and compared with those from 2015 to 2020. National practice trends observed in these data were evaluated and reviewed alongside published literature and evidence-based medicine. Results: In total, 780 patients with flexor tendon laceration injuries were included. Mean patient age was 38 years; mean time between tendon injury and first evaluation was 4 days, and the mean time from injury to operative repair was 12 days. Four-strand sutures remain the most common technique of tendon repair (57%). In the recent cohort, there were significant decreases in tourniquet use (94% versus 89%), general anesthesia (88% versus 74%), and monofilament sutures (44% versus 35%), with a significant increase reported in preserving the A1 pulley (20% versus 29%). Postoperative movement was described as "almost full range of motion" or "good" in 70% of cases, and 74% of patients were satisfied with their results. Postoperative adverse events were reported in 26% of cases, with the most common complications being tendon adhesions (14%) and rupture (3%). Conclusions: Review of The American Board of Plastic Surgery tracer data for operative repair of flexor tendon lacerations establishes a framework by which surgeons can evaluate how their current practice aligns with that of their peers, and whether their practice patterns remain current relative to recommendations from evidence-based medicine.

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“…Future tracer data may show a decline in the usage of antibiotics. 64 Clear guidelines remain to be established.…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns in Operative Flexor Tendon Laceration Repair: A 15-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery

Weissman

Sasson

Chappell

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Patients prescribed antibiotics unnecessarily may have drug or allergic reactions or may develop other infections, such as pseudomembranous colitis due to C. difficile. 8 A previous prospective study of 149 consecutive patients undergoing open reduction and internal fixation of a closed ankle fracture showed no significant…”

Section: Introductionmentioning

confidence: 94%

“…Patients prescribed antibiotics unnecessarily may have drug or allergic reactions or may develop other infections, such as pseudomembranous colitis due to C. difficile . 8 …”

Section: Introductionmentioning

confidence: 99%

Antibiotic Prophylaxis for Distal Interphalangeal Joint Arthrodesis

Vohra

Beck

Barrett

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…The survey demonstrated that 5% of surgeons did not prescribe preoperative antibiotics for any procedures, including those that involved imbedded hardware. 1 This study demonstrated that the use of preoperative antibiotics is random and not standardized.…”

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confidence: 90%

The Use of Preoperative Antibiotics in Hardware-Based Hand Procedures Is Not Necessary

2023

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Background A survey to American Society for Surgery of the Hand members by Dunn et al showed that the use of preoperative antibiotics was random and not standardized for all hand procedures (Hand (N Y). 2020;15(4):534–541). Previous publications support that preoperative antibiotics for clean, soft-tissue procedures are not necessary, but there is minimal evidence regarding the need for preoperative antibiotics for hardware-based hand procedures. The purpose of our study is to compare infectious outcomes for patients undergoing hardware-based hand surgery between those who did and those who did not receive preoperative antibiotics. Methods A retrospective cohort analysis was performed on hardware-based surgical patients from the senior author's hand practice between January 2015 and October 2021. All patients either received imbedded permanent hardware or temporary percutaneous k-wire fixation. Exclusion criteria included polytrauma patients, patients with open hand wounds, and patients with less than 2 outpatient follow-up visits. Primary outcomes measured were 30- and 90-day postoperative antibiotic prescriptions and need to return to the operating room. Basic demographic information such as age, sex, body mass index, diabetes, and smoking status were recorded and compared. Results Four hundred seventy-two patients were reviewed, with 365 patients meeting inclusion and exclusion criteria. Two hundred twenty patients did not receive preoperative antibiotics and 145 patients did receive preoperative antibiotics. χ2 tests to analyze for associations between the variables were used. Thirteen patients in the no preoperative antibiotic group (5.9%), compared with 5 patients in the preoperative antibiotic group (3.4%), received a postoperative antibiotic prescription within 30 days (P = 0.288). Sixteen patients in the no preoperative antibiotic group (7.3%), compared with 8 patients in the preoperative antibiotic group (5.5%) received a postoperative antibiotic prescription within 90 days (P = 0.508). One patient in the nonantibiotic group required return to the operating room for irrigation and debridement. Conclusions There are no significant differences in the need for 30- and 90-day postoperative antibiotic prescriptions between those who did or did not receive preoperative antibiotics based on this single-surgeon experience.

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Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Cited by 12 publications

References 50 publications

Practice Patterns in Operative Flexor Tendon Laceration Repair: A 15-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery

Practice Patterns in Operative Flexor Tendon Laceration Repair: A 15-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery

Antibiotic Prophylaxis for Distal Interphalangeal Joint Arthrodesis

The Use of Preoperative Antibiotics in Hardware-Based Hand Procedures Is Not Necessary

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