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Are Antibiotics Necessary in Adult Upper Extremity Surgery with Hardware?
Yufan Yan, MD
1; Nathan Khabyeh-Hasbani, BA
1; Joey S. Kurtzman, BA
1,2; Rami Abuqubo, BS
1; Joshua Cohen, BS
1; Steven M Koehler, MD
11Montefiore Medical Center, Bronx, NY; 2Wake Forest School of Medicine, Winston Salem, NC
Introduction: Although it is well established that antibiotic prophylaxis is not needed in soft tissue upper extremity cases, there is still no strong consensus on whether this holds true when hardware is involved. We hypothesize that antibiotic prophylaxis is not necessary and there is no difference in postoperative surgical site infection rates regardless of preoperative antibiotic administration.
Methods: A retrospective cohort analysis was performed on hardware-based upper extremity surgical cases performed at a single institution between November 2021 and November 2023. All patients who underwent implantation of a foreign device were included. Exclusion criteria included patients under the age of 18, administration of antibiotics in the immediate postoperative period, and those with less than 30 days of follow-up. Implants included plates, screws, Kirschner wires, and suture anchors. Patient demographic factors and operative details were collected including age, sex, BMI, laterality, smoking status, medical comorbidities calculated as Charlson Comorbidity Index, administration of perioperative antibiotics, hardware type, and length of procedure. Primary outcome measures were diagnosis of surgical site infection by 14 days and 30 days. Secondary outcomes included management with antibiotic treatment, operative washout, or hardware removal if diagnosed with an infection. Categorical variables were compared using Fisher's exact test, and continuous variables were compared using Wilcoxon rank-sum test. Significance was defined by p-value < 0.05.
Results: A total of 232 patients were included for analysis – 152 received antibiotic prophylaxis and 80 did not. There was no difference between the two groups in terms of demographic factors, comorbidities, or smoking status. Overall postoperative infection rate was 3%, and there was no difference in infection rates between the group who received antibiotic prophylaxis and the group who did not. Infection rate in the antibiotic prophylaxis group was 4.6% and in the no antibiotics group was 2.5%. The vast majority of patients had implantation of metallic hardware such as a plate and/or screws (71%). Suture anchors accounted for 16%, and Kirschner wires 10%. There was no correlation between type of hardware and risk for infection.
Conclusion: Antibiotic prophylaxis is not necessary in upper extremity surgical cases even when implantation of hardware is involved. There is no difference in postoperative infection rates whether antibiotic prophylaxis is administered.Surgeons should reconsider the need for antibiotic prophylaxis in upper extremity cases in adults.
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