Prophylactic antibiotic use in elective hand surgery does not trend toward lower rates of SSI

LAS VEGAS — A retrospective chart review of 1,067 elective hand surgery procedures indicates a low rate of surgical site infections, with most being superficial wound infections, and underscores a trend that the use of prophylactic antibiotics did not lead to decreased risk of surgical site infection.

“Our overall infection rate for our whole study population was 2.8%,” Katharine T. Criner, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting. “The majority of our wound infection were superficial, with a superficial infection rate of 2.1%. Our deep infection rate was 0.7%. Our soft tissue infection rate was 1.4%, and our infection rate in patients who had bone and joint work or implants used was 3.8%. Prophylactic antibiotics did not decrease the rate of postoperative infections for our entire study population. However our main study weakness, in addition to being retrospective in nature, is that in terms of our bone, joint and implant subgroup, it was underpowered so it is purely just a trend that prophylactic antibiotics did not decrease the risk of infection in this subgroup.”

Criner and her colleagues reviewed the complete charts of adult patients with more than 2 weeks of postoperative follow-up who underwent elective hand surgery performed by six hand surgeons at a single institution. In addition to grouping patients according to whether they received prophylactic antibiotics in the OR, the researchers further categorized patients based on whether they underwent soft tissue procedures or surgery that involved implantation or work on the bone or joints. There were 390 patients who had surgery using implants or involving the bone or joints and received antibiotics and 248 patients in this subgroup who did not. Overall, the study population had a mean age of 47 years and there was no significant differences in demographics between the antibiotics and no antibiotics group.

Katharine T. Criner

The researchers discovered 30 cases of wound infection in the entire study population (2.8%). Twenty infections occurred in the antibiotics group (3.7%) vs. 10 infections in the antibiotics group (1.9%). However, this difference was not statistically significant, she said.

An additional analysis of patients in the bone, joint and implant subgroup showed patients who received antibiotics had an infection rate of 4.1% and patients who did not receive antibiotics had an infection rate of 3.2%. This finding was not statistically significant. Similarly, patients who underwent soft tissue procedures and had antibiotics had an infection rate of 2.7% vs. 0.7% for patients who did not have antibiotics. – by Gina Brockenbrough, MA

Reference:

Criner KT, et al. Paper 113. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-27, 2015; Las Vegas.

Disclosure: Criner reports no relevant financial disclosures.