Timing of Antibiotic Prophylaxis for Preventing Surgical Site Infections in Foot and Ankle Surgery

Tantigate, Direk; Jang, Eugene; Seetharaman, Mani; Noback, Peter C.; Heijne, Anna M.; Greisberg, Justin

doi:10.1177/1071100716674975

Cited by 16 publications

(15 citation statements)

References 32 publications

(42 reference statements)

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“… • No description of type of surgery/co-morbidities/ASA grade etc. Study Name Tantigate et al (2016) Retrospective Comparative Study [ 28 ] Participants • Retrospective chart review of 1933 ft and ankle procedures in 1632 patients over a 56 month period. Intervention • Demographic data, type of antibiotics/dosage/timing were recorded along with rate of postoperative infection.…”

Section: Resultsmentioning

confidence: 99%

“…No studies appraised type and duration of foot and ankle surgery as independent variables influencing SSI rates, with the exception of Tantigate el al. postulating via the findings in their study, that independent predictors of postoperative infection were ASA Grade, non-ambulatory surgery and a longer duration of surgery, with almost 92% of the risk of a postoperative infection being predicted by these factors ( P > 0.05) alone [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

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Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Modha

Morriss-Roberts

Smither

et al. 2018

Journal of Foot and Ankle Research

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BackgroundWith the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.MethodologyA systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.ResultsOverall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.ConclusionWhilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Modha

Morriss-Roberts

Smither

et al. 2018

Journal of Foot and Ankle Research

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“…26 The rate at which postoperative infections occur specifically in foot and ankle surgery has been reported at an average of 4%. 10,14,24 Postoperative SSIs have a broad impact, with studies showing that patients who developed an SSI were 5 times more likely to be readmitted to the hospital, increasing costs and length of stay. 11,20 Additionally, the rate at which SSIs occur is used as a quality measure by the Centers for Medicare & Medicaid Services.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery

et al. 2022

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Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery. Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019. Patients were divided into 2 groups: those who received postoperative oral antibiotics (group 1) and those who did not (group 2). Two surgeons routinely prescribed postoperative oral antibiotics, and 2 did not. Demographics, comorbidities, and procedure complexity based on surgical site and Current Procedural Terminology code were recorded from the charts. The primary outcome was postoperative infection (superficial or deep) within 6 months after surgery. Patients with antibiotic use prior to surgery, preoperative infection, or lack of follow-up >6 weeks were excluded. Multivariate logistic regression modeling was used to analyze differences in infection rate and severity. Results: Chart review identified 3631 patients, 1227 of whom did not receive postoperative oral antibiotics whereas 2394 patients did. Routine postoperative oral antibiotic use did not significantly affect postoperative infection rates or severity. However, all covariates studied (diabetes, hypertension, obesity, tobacco use, alcohol use, rheumatoid conditions, and age) influenced postoperative infection rates and severity. Conclusion: The results of this study indicate that postoperative oral antibiotics are not associated with differences in infection rates or severity. We do not recommend routine use in foot and ankle surgery.

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“…12 In the setting of a closed fracture, the rate of surgical site infection would be expected to be on par with any clean procedure, as it was in this case. 14 The second most common complication was neurapraxia, with an incidence of 4.0%. Hardware-related discomfort without hardware removal 16 (4.0)…”

Section: Discussionmentioning

confidence: 99%

Fibular Plate Fixation and Correlated Short-term Complications

Bäcker

Greisberg

2019

Foot & Ankle Specialist

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Background. The most common method of surgical stabilization of fibular fractures is plate osteosynthesis. Despite its ubiquity, there is a dearth of large series reporting implant-related outcomes and complications. The purpose of this study was to report on short-term complications and hardware removal after plate fixation of distal fibula fractures. Methods. A retrospective chart analysis and review of radiographic images was performed of 461 ankle fractures between 2011 and 2017. In 404 cases, a fibular fracture was treated surgically; 94.1% underwent tubular and 5.9% locking plate fixation. The primary outcome was radiographic union, with a mean follow-up of 11.6 months. Minor, intermediate, and major complications were recorded as well as the rate of hardware removal. Results. The union-rate with plate fixation was 99.5% (402/404). The overall complication rate was 19.3% (n = 78/404). Of these complications, 79.5% (62/78) were considered minor. These complications included erythema, heterotopic ossification, neurapraxia, delayed union, and deep-vein thrombosis; 20.5% (16/78) of the complications were considered intermediate (9/78, 11.5%) or major (7/78, 9.0%). Intermediate and major complications included deep infection, nonunion/malunion, and osteomyelitis. Subsequent surgery was needed in 7 cases (1.7%, 7/404). In another 93 patients, hardware-related symptoms were identified: 23 (5.7%) underwent syndesmosis screw removal and 54 (13.4%) hardware removal. No correlation to the fixation technique was identified. Conclusion. This study shows a relatively low rate of major complications and a high union rate of 99.5% for fibular plate osteosynthesis in a large cohort. Any other treatment, including other fixation techniques, will need to show an equivalent or better complication and reoperation profile.Level of Evidence: Level III: Retrospective, comparative study

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Timing of Antibiotic Prophylaxis for Preventing Surgical Site Infections in Foot and Ankle Surgery

Abstract: Level III, retrospective comparative study.

Cited by 16 publications

References 32 publications

Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery

Fibular Plate Fixation and Correlated Short-term Complications

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