Abstract:BACKGROUND National Institute for Health and Care Excellence (NICE) CG74 has set out evidence-based guidance on which types of surgery require antibiotic prophylaxis. Our aim was to establish what the current practice for antibiotic prophylaxis in Dupuytren's surgery is amongst hand surgeons in the United Kingdom, through the British Society for Surgery of the Hand (BSSH). METHODS Permission was granted for our online survey to be distributed to BSSH hand surgeons via consecutive BSSH e-bulletins. Hand surgeon… Show more
“…Studies assessing databases of medical claims were excluded from the meta-analysis, observing partial overlapping of confidence intervals and more or less similar effect estimates in the forest plot, as well as results that are consistent with those of the initial meta-analysis (Fig. 6 ) [ 6 , 7 ]. Also, meta-analyses using fixed and random effects models had the same conclusions (Fig.…”
Section: Resultsmentioning
confidence: 99%
“… Fig. 6 Sensitivity analysis: exclusion of studies performed in databases of medical claims [ 6 , 7 ] Fig. 7 Forest plot: fixed and random effects model (R software) …”
Section: Resultsmentioning
confidence: 99%
“…In this context, a recent international study with members of the American Society of Surgeons of the Hand showed that around half of the surgeons did not prescribe prophylactic antibiotics for the surgical treatment of carpal tunnel syndrome [ 5 ]. Likewise, an interview with members of the British Society for Surgery of the Hand found that around 80% of surgeons did not prescribe them for the surgical treatment of Dupuytren’s disease [ 6 ]. Prior to surgery, 13.6% (2009e2015) of patients received prophylactic intravenous antibiotics and trend analysis showed a statistically significant increase from 2009 (10.6%) to 2015 (18.3%), an increase of 72.5% [ 7 ].…”
Section: Introductionmentioning
confidence: 99%
“…However, observational, nonrandomized, nonblinded, single-center studies and, mainly, with a statistical power compromised by a sample size that is not large enough and representative of the investigated effect, have prevented the development of specific guidelines for careful antibiotic prophylaxis in these surgeries [ 8 , 9 ]. As a result, decisions about the administration of preoperative antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb are still based on the institution’s traditions and the surgeon’s preferences [ 1 , 5 , 6 , 9 , 10 ].…”
Background
Surgical site infections (SSI) are the most frequent early complications of hand surgeries. However, the indications still remain uncertain for antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb. Therefore, a systematic review of the literature and a meta-analysis was conducted to investigate the impact of antibiotic prophylaxis on the prevention of SSI in these types of surgeries.
Methods
An electronic search was performed in the following databases: MEDLINE/Pubmed, PMC/Pubmed, Web of Science/Clarivate Analytics, Embase/Elsevier, Scopus/Elsevier, BVS/Lilacs, and the Cochrane Library, with no restrictions regarding publication language or date. The primary outcome of interest was the occurrence of SSI following elective clean soft tissue surgeries of the hand and upper limb according to the administration of preoperative antibiotic prophylaxis and no antibiotic prophylaxis. Surgeries involving simultaneous bone procedures or orthopedic implants were excluded. Study selection and data extraction were conducted independently by two reviewers. RoB 2.0 and ROBINS-I are Cochrane risk-of-bias tool for randomized trials and non-randomized studies of interventions. The magnitude of the intervention effect was estimated using the relative risk (RR). The meta-analysis was performed with the Review Manager and R software tools, using the Mantel–Haenszel random-effects model and a 95% confidence interval (CI). Results with p ≤ 0.05 were considered statistically significant. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Results
The initial search yielded 1175 titles, from which 12 articles met the inclusion criteria for the systematic review, and 10 were included in the subsequent meta-analysis. The majority of these studies were nonrandomized intervention trials, exhibiting a moderate risk of bias. According to our review, preoperative antibiotic prophylaxis did not have a statistically significant impact on the incidence of SSI (RR = 1.13, 95% CI 0.91–1.40, p = 0.28). The overall quality of evidence for this outcome was rated as low. Moderate statistical heterogeneity was observed (I2 = 44%), and the prespecified sensitivity analysis highlighted the consistency of the results.
Conclusions
While these results were consistent with the findings from individual studies included in this review, it is important to note that, given the threshold of p ≤ 0.05 for statistical significance, no definitive conclusions can be drawn from the quantitative analysis of the data obtained.
Level of evidence: Level 2.
Trial registration: CRD42023417786.
“…Studies assessing databases of medical claims were excluded from the meta-analysis, observing partial overlapping of confidence intervals and more or less similar effect estimates in the forest plot, as well as results that are consistent with those of the initial meta-analysis (Fig. 6 ) [ 6 , 7 ]. Also, meta-analyses using fixed and random effects models had the same conclusions (Fig.…”
Section: Resultsmentioning
confidence: 99%
“… Fig. 6 Sensitivity analysis: exclusion of studies performed in databases of medical claims [ 6 , 7 ] Fig. 7 Forest plot: fixed and random effects model (R software) …”
Section: Resultsmentioning
confidence: 99%
“…In this context, a recent international study with members of the American Society of Surgeons of the Hand showed that around half of the surgeons did not prescribe prophylactic antibiotics for the surgical treatment of carpal tunnel syndrome [ 5 ]. Likewise, an interview with members of the British Society for Surgery of the Hand found that around 80% of surgeons did not prescribe them for the surgical treatment of Dupuytren’s disease [ 6 ]. Prior to surgery, 13.6% (2009e2015) of patients received prophylactic intravenous antibiotics and trend analysis showed a statistically significant increase from 2009 (10.6%) to 2015 (18.3%), an increase of 72.5% [ 7 ].…”
Section: Introductionmentioning
confidence: 99%
“…However, observational, nonrandomized, nonblinded, single-center studies and, mainly, with a statistical power compromised by a sample size that is not large enough and representative of the investigated effect, have prevented the development of specific guidelines for careful antibiotic prophylaxis in these surgeries [ 8 , 9 ]. As a result, decisions about the administration of preoperative antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb are still based on the institution’s traditions and the surgeon’s preferences [ 1 , 5 , 6 , 9 , 10 ].…”
Background
Surgical site infections (SSI) are the most frequent early complications of hand surgeries. However, the indications still remain uncertain for antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb. Therefore, a systematic review of the literature and a meta-analysis was conducted to investigate the impact of antibiotic prophylaxis on the prevention of SSI in these types of surgeries.
Methods
An electronic search was performed in the following databases: MEDLINE/Pubmed, PMC/Pubmed, Web of Science/Clarivate Analytics, Embase/Elsevier, Scopus/Elsevier, BVS/Lilacs, and the Cochrane Library, with no restrictions regarding publication language or date. The primary outcome of interest was the occurrence of SSI following elective clean soft tissue surgeries of the hand and upper limb according to the administration of preoperative antibiotic prophylaxis and no antibiotic prophylaxis. Surgeries involving simultaneous bone procedures or orthopedic implants were excluded. Study selection and data extraction were conducted independently by two reviewers. RoB 2.0 and ROBINS-I are Cochrane risk-of-bias tool for randomized trials and non-randomized studies of interventions. The magnitude of the intervention effect was estimated using the relative risk (RR). The meta-analysis was performed with the Review Manager and R software tools, using the Mantel–Haenszel random-effects model and a 95% confidence interval (CI). Results with p ≤ 0.05 were considered statistically significant. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Results
The initial search yielded 1175 titles, from which 12 articles met the inclusion criteria for the systematic review, and 10 were included in the subsequent meta-analysis. The majority of these studies were nonrandomized intervention trials, exhibiting a moderate risk of bias. According to our review, preoperative antibiotic prophylaxis did not have a statistically significant impact on the incidence of SSI (RR = 1.13, 95% CI 0.91–1.40, p = 0.28). The overall quality of evidence for this outcome was rated as low. Moderate statistical heterogeneity was observed (I2 = 44%), and the prespecified sensitivity analysis highlighted the consistency of the results.
Conclusions
While these results were consistent with the findings from individual studies included in this review, it is important to note that, given the threshold of p ≤ 0.05 for statistical significance, no definitive conclusions can be drawn from the quantitative analysis of the data obtained.
Level of evidence: Level 2.
Trial registration: CRD42023417786.
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