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Antibiotic prophylaxis ineffective at preventing infection following hand surgery

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SAN FRANCISCO — Antibiotic prophylaxis provided no added protection against surgical site infection after elective soft tissue hand surgery, according to an investigator from Philadelphia who presented the findings at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.

Deep surgical infections of the hand can have deleterious effects [including] fibrosis, stiffness, loss of function, even amputation in the extreme can complicate these procedures,” Richard J. Tosti, MD, said. “Antibiotics given peri-operatively are intended to reduce the rate of these complications, however they do introduce complications themselves.”

Data are not available in the literature to indicate whether antibiotic prophylaxis is even necessary after hand surgery, Tosti said.

He and colleagues retrospectively reviewed 635 elective soft tissue hand surgeries, which included carpal tunnel release, mass excision, first dorsal compartment release and tenolysis performed from 2007 to 2010. They recorded demographics and used the presence of a surgical site infection within 30 days as the outcome measure, as recommended by the U.S. Centers for Disease Control and Prevention. Researchers conducted a univariate analysis to define risk factors.

The investigators found a 0.9% overall infection rate. Patients given antibiotics showed a 1.29% infection rate and those not receiving antibiotics had a 0.75% infection rate. For patients who underwent tenolysis, there was an 8.46 times increased chance of contracting a surgical site infection.

“We failed to reject our null hypothesis,” Tosti said. “Our study does not support the use of antibiotics in clean soft tissue hand procedures. I do think this information has implications for health policy in future research.”

Reference:

• Tosti RJ, Fowler JR, Dwyer J, et al. Is antibiotic prophylaxis necessary in clean soft tissue hand surgery? Paper #111. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
• Disclosure: Tosti has no relevant financial disclosures.