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Antibiotics fail to prevent infection after elective soft tissue hand surgery
Infection rates were not significantly different between patients who received antibiotic prophylaxis for soft tissue hand surgery and those that did not.
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SAN FRANCISCO — Antibiotic prophylaxis provided no additional protection against surgical site infection after elective soft tissue hand surgery, according to research presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting and highlighted in the Best of the AAOS Symposium.
“Deep surgical infections of the hand can have deleterious effects [including] fibrosis, stiffness, loss of function and even amputation in the extreme [case] can complicate these procedures,” Richard J. Tosti, MD, said during his presentation. “Antibiotics given perioperatively are intended to reduce the rate of these complications; however, they do introduce complications themselves. Furthermore, the benefit profile of giving these drugs perioperatively has yet to be defined in the hand population.”
He noted that published studies do not indicate whether antibiotic prophylaxis is necessary after hand surgery and that evidence is only available for traumatic hand surgery or carpal tunnel release.
Tosti and colleagues retrospectively reviewed 635 elective soft tissue hand surgeries including carpal tunnel releases, mass excisions, first dorsal compartment releases and tenolyses performed between 2007 and 2010. They used the presence of a surgical site infection within 30 days as the outcome measure, as recommended by the Centers for Disease Control and Prevention.
The investigators found a 0.9% overall infection rate, and all of the infections were considered to be superficial. In the series, Tosti noted that no cases of infection required surgical management.Patients given antibiotics showed a 1.29% infection rate, and those without antibiotics had a 0.75% infection rate.
“Looking at the superficial infection rate, we see that the differences were not statistically significant when either using or bypassing antibiotics perioperatively,” Tosti said.
Compared to other procedures, the investigators discovered a higher odds of infection with tenolysis.
“For patients who underwent tenolysis, there was an 8.46 times increased chance of contracting a surgical site infection,” Tosti said.
He noted that the higher risk of infection for these patients could be the result of confounding variables. Tosti told Orthopedics Today, “In both of those cases, the operative times were greater than 2 hours, had extensive dissection and were re-operations.”
During his presentation Tosti added, “We failed to reject our null hypothesis. 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.” – by Renee Blisard
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.
For more information:
- Richard J. Tosti, MD, can be reached at Department of Orthopaedic Surgery and Sports Medicine, Temple University, 3401 North Broad St., Suite 400, Philadelphia, PA 19140; 215-707-5080; email: rtosti@temple.edu.
- Disclosure: Tosti has no relevant financial disclosures.