Effectiveness of Preoperative Antibiotics in Preventing Surgical Site Infection After Common Soft Tissue Procedures of the Hand

Li, Kevin; Sambare, Tanmaya D.; Jiang, Sam Y.; Shearer, Emily; Douglass, Nathan; Kamal, Robin N.

doi:10.1007/s11999.0000000000000073

Cited by 33 publications

(28 citation statements)

References 37 publications

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“…To address this challenge, Li et al recently published a population-based analysis of 516,986 patients who underwent soft-tissue hand surgical procedures to assess the effect of antibiotic prophylaxis on the surgical site infection rate; the study used propensity score matching, controlled for potential confounding variables (e.g., patient demographic characteristics, procedure type, medication use, and comorbidities), and was appropriately powered for negative results. This analysis, similar to prior findings in the literature, did not find a significant treatment effect of preoperative antibiotic prophylaxis (odds radio, 1.03; p = 0.585) 13 . Although not a randomized controlled trial and limited by the nature of database investigations, the study provides a robust and adequately powered analysis of the use of antibiotic prophylaxis in soft-tissue hand surgical procedures.…”

Section: Evidence Against Routine Prophylaxissupporting

confidence: 90%

“…The importance of preoperative prophylactic antibiotics has been established for several orthopaedic procedures [7][8][9][10][11][12][13]33 . In a double-blinded, placebo-controlled randomized trial, Pavel et al found that prophylactic antibiotics reduced the postoperative infection rate in clean orthopaedic procedures; the study included orthopaedic procedures throughout the body (e.g., hand, wrist, forearm, spine, and knee) but did not perform a subgroup analysis to identify the differences ininfection rates between groups on the basis of the surgical site 34 .…”

Section: Evidence Supporting Routine Prophylaxismentioning

confidence: 99%

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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: Evidence Against Routine Prophylaxissupporting

confidence: 90%

Section: Evidence Supporting Routine Prophylaxismentioning

confidence: 99%

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 authors concluded that their findings do not support prophylaxis except in particular conditions under which a specific patient may have a high baseline infection risk. A well-conducted meta-analysis 11 and a large database review from an American insurance repository 36 concluded that preoperative antibiotic prophylaxis does not lower the risk of SSI while controlling for patient and surgical risk factors. Despite these findings, one recent review found an increase in antibiotic use in hand surgery by 73% between 2009 and 2015.…”

Section: Discussionmentioning

confidence: 99%

“…34 Despite the evidence against routine antibiotic prophylaxis in hand surgery, antibiotics are given preoperatively in 10% to 30% of clean, elective hand procedures. 10,35,36 The factors associated with unnecessary antibiotic treatment in hand surgery are not known. The primary aims of this study are to determine for which scenarios surgeons give antibiotics, the reasons for administration, and whether these decisions are evidence-based.…”

mentioning

confidence: 99%

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

Dunn

Means

Desale

et al. 2018

Hand (New York, N,Y.)

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Background: There are no clearly defined guidelines from hand surgical societies regarding preoperative antibiotic prophylaxis. Many hand surgeons continue to routinely use preoperative prophylaxis with limited supporting evidence. This study aimed to determine for which scenarios surgeons give antibiotics, the reasons for administration, and whether these decisions are evidence-based. Methods: An anonymous 25-question survey was e-mailed to the 921-member American Society for Surgery of the Hand listserv. We collected demographic information; participants were asked whether they would administer antibiotics in a number of surgical scenarios and for what reasons. Respondents were broken into 3 groups based on when they said they would administer antibiotics: Group 1 (40 respondents) would give antibiotics in the case of short cases, healthy patients, without hardware; group 2 (9 respondents) would not give antibiotics in any scenario; and group 3 (129 respondents) would give antibiotics situationally. The Fisher exact test compared demographic variables, frequency of use, and indications of antibiotic prophylaxis. Results: Of the 921 recipients, 178 (19%) responded. Demographic variables did not correlate with the antibiotic use group. Operative case time >60 minutes, medical comorbidity, and pinning each increased antibiotic use. Group 1 respondents were more likely to admit that their practice was not evidence-based (74.4%) and that they gave antibiotics for medical-legal concern (75%). Twenty-two percent of respondents reported seeing a complication from routine prophylaxis, including Clostridium difficile infection. Conclusions: Antibiotics are still given unnecessarily before hand surgery, most often for medical-legal concern. Clear guidelines for preoperative antibiotic use may help reduce excessive and potentially inappropriate treatment and provide medical-legal support.

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“…Complication rates of these methods are similar; the most frequently identified post-surgery complication is wound infection [9]. Median nerve injury is a very rare complication during carpal tunnel syndrome surgery [10]. All the defined techniques are sufficient to release the median nerve.…”

Section: Discussionmentioning

confidence: 99%

Modified mini-incision surgery for carpal tunnel syndrome: Results of 131 interventions

Asan¹

2018

Ann Clin Anal Med

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Aim: The aim was the presentation of results from 131 interventions in which a quick and practical modified surgical approach was applied in carpal tunnel syndrome surgery. Material and Method: In total, 131 surgical interventions were made in 121 cases. 22 cases were male, 99 cases were female. Boston Carpal Tunnel Syndrome Questionnaire scores were obtained on the postoperative 12th-14th day and compared with the preoperative scores. All cases were performed with local anesthesia. In all cases, surgical equipment consisted of one no-15-blade, one automatic retractor, and one 45 cm prolene 3-0. Results:According to EMG results, 71 patients had severe, 49 patients had moderate, and 11 patients had moderate-mild carpal tunnel syndrome. The average time for the surgery was 7.2 minutes. During surgery, one automatic retractor was used, and manipulations that shorten the time of surgery and increase surgical safety have been described. The average incision length was 1.5-2 cm. Subcuticular skin suture was not performed. The stitches were removed on the 12th postoperative day. Seven cases presented wound site inflammation. Relapse in the latter course was not encountered in any case. Discussion: The method described as a modification of mini-incision surgery is thought to be reliable, comfortable, and cost-effective. Use of an automatic retractor considerably shortens surgical time and facilitates surgery. Not performing subcuticular suture reduces the probability of relapse. In cases with a high risk factor for infection, treatment of the wound site requires further care.

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Effectiveness of Preoperative Antibiotics in Preventing Surgical Site Infection After Common Soft Tissue Procedures of the Hand

Abstract: Level III, therapeutic study.

Cited by 33 publications

References 37 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 Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Modified mini-incision surgery for carpal tunnel syndrome: Results of 131 interventions

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