Foregoing Pre-Operative Antibiotics in Clean, Implant-Based Hand Procedures
Emma Susan Dahmus, MD, MBA1; Brian Foster, MD1; Clarice Callahan, MD2; Julia Schroer, MD, MBA3; C. Liam Dwyer, MD4; Louis C Grandizio, DO1; Joel C. Klena, MD5; Glen Jacob, MD6
1Geisinger Medical Center, Danville, PA; 2Michigan State University Medical School, Grand Rapids, MI; 3Geisinger Commonwealth School of Medicine, Scranton, PA; 4Orthopaedics, UPMC Hamot, Erie, PA; 5Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA; 6Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
INTRODUCTION: While recent data support foregoing routine pre-operative antibiotics for clean, outpatient, soft-tissue procedures, there is a paucity of evidence for implant-based hand procedures. The purpose of our study is to investigate early post-operative infections for patients undergoing implant-based hand surgery. We hypothesized that, in patients who do not receive pre-operative antibiotics, there would not be an increase in use of post-operative antibiotic prescriptions or reoperations for infection within 90 days of surgery.
METHODS: A retrospective cohort analysis was performed including all patients undergoing outpatient surgical procedures involving implants by five fellowship-trained hand surgeons between January 2015 and October 2021. Exclusion criteria included polytrauma patients, patients with open wounds, and patients with less than two outpatient follow-up visits. Primary outcomes measured were 30- and 90-day prescribed antibiotics for surgical-site specific concerns, and the need to return to the operating room. Basic demographic information such as age, sex, BMI, diabetes, and smoking status were recorded and compared. Patients were additionally split into percutaneous and retained hardware groups.
RESULTS: 1,483 implant-based procedures from 1,401 unique patients were reviewed. 1,231 (83%) procedures received pre-operative antibiotics compared to 252 that did not receive pre-operative antibiotics. There were no significant differences in demographics between the pre-operative antibiotics and the no pre-operative antibiotics groups. Overall, 54 (3.6%) and 68 (4.6%) patients were prescribed antibiotics within 30- and 90-days of their hand procedures, respectively. There were no significant differences in 30-day (p = 0.159) or 90-day (p = 0.145) post-operative antibiotic prescriptions between those who did and did not receive pre-operative antibiotics. One patient in the non-antibiotic group required return to the operating room for irrigation and debridement.
Male sex was associated with increased use of post-operative antibiotics at 30- (5.2% vs 2.3%, p = 0.003) and 90-days (6.2% vs 3.2%, p = 0.039). Compared to retained hardware, percutaneous hardware was associated with increased use of post-operative antibiotics at 30- (6.6% vs 2.1%, p < 0.001) and 90-days (7.6% vs 3.0%, p < 0.001). Diabetes and smoking were not associated with increased use of post-operative antibiotics at 30- (p = 0.7 and p = 0.093, respectively) and 90-days (p = 0.7 and p = 0.13, respectively).
CONCLUSION: For implant-based hand procedures, there were no significant differences in 30- or 90-day post-operative antibiotic prescriptions between those who did and did not receive pre-operative antibiotics. Male sex and percutaneous hardware were risk factors for increased use of post-operative antibiotics.
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