The Impact of Clinical Practice Guidelines on Preoperative Antibiotic Administration for Carpal Tunnel Release

Abstract

Background: In 2015, the American Association of Plastic Surgeons (AAPS) published a consensus statement against the routine use of preoperative antibiotic prophylaxis to prevent surgical site infection in clean hand surgery. The American Academy of Orthopaedic Surgeons (AAOS) similarly cited “insufficient evidence” in its Appropriate Use Criteria guidelines to support the use of antibiotics in carpal tunnel surgery. Nonetheless, its administration remains a common practice during clean hand surgery. We sought to evaluate the impact of the above guidelines on preoperative antibiotic administration. Methods: An institutional review board–approved retrospective chart review of consecutive patients with carpal tunnel syndrome treated with open carpal tunnel release (CTR) at our institution was performed in the 2 years before and after publication of AAPS/AAOS guidelines. Patient demographics and surgical outcomes were reviewed. Incidence of antibiotic administration, patient demographics, and surgeon factors were collected. Results: A total of 770 primary open CTR procedures were performed in the studied years. In 2013 and 2014, 83.9% of patients received preoperative antibiotics. In 2017 and 2018, 48.2% of patients received preoperative antibiotics. Of the variables analyzed, immunosuppression, history of diabetes, and poorly controlled diabetes (A1c > 7) were found to be statistically significant in its positive correlation to prophylactic preoperative antibiotic use. Diabetes was not associated with surgical site infections. Conclusion: Patients were more likely to receive preoperative antibiotics before the publication of the AAPS/AAOS clinical practice guidelines. Patients with diabetes regardless of their glycemic control are more likely to receive preoperative antibiotics.

Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis

“…In our review, only 0.2% of patients ( n = 24/14,255) demanded new surgical procedures and/or hospitalization related to SSI [ 4 , 15 , 16 , 19 – 23 ]. Also, the prescription of preoperative prophylactic antibiotics had no impact on the incidence of SSI when compared with the administration of placebo or no prophylaxis (RR = 1.13; 95% CI 0.91–1.40; z = 1.1; p = 0.28).…”

What’s New in Hand and Wrist Surgery

“…Zheng and Fowler further corroborated this information and reported that prophylactic antibiotic administration did not lower the rate of surgical site infection in cubital tunnel surgery 50 . Even so, in a retrospective chart review, 48.2% of patients still received prophylactic antibiotics before CTR surgery from 2017 to 2018 51 . However, this is an improvement from before the guidelines went into effect, when 83.9% of patients received antibiotics before CTR.…”