The Effectiveness of Preoperative Antibiotic Prophylaxis in Ulnar Nerve Release at the Cubital Tunnel

Although the literature supports not using preoperative antibiotic prophylaxis for clean soft tissue procedures around the hand, there is limited data for soft tissue procedures around the elbow, such as cubital tunnel release. Complications of postoperative infection include scarring, stiffness, and rarely, amputation. The purpose of this study is to determine if preoperative antibiotic prophylaxis decreases the risk of surgical site infection for cubital tunnel release.

A retrospective review of 919 in situ, subcutaneous transposition, and submuscular transposition cubital tunnel surgery at a tertiary care center was performed. Patient records were searched to determine preoperative antibiotic status and infection within 30 days of surgery. In addition, comorbidities and demographics such as age, race, sex, and past medical history were also identified. Comorbidities with qualitative variables were analyzed with odds ratio, Chi-squared, and Fisher's Exact test, linear variables analyzed with t-test.

There were 5/296 (1.7%) infections in patients without preoperative antibiotics, and 17/623 (2.7%) infections in patients with preoperative antibiotics. Patients who had received preoperative antibiotics had no significant change in infection rate (95% odds ratio: 0.597-1.633). Other variables, such as age, body mass index, race, surgeon, insurance type, diabetes, depression, anxiety, arthritis, concurrent surgeries, and hyperlipidemia were also not significant for risk of infection.

Preoperative antibiotics do not demonstrate benefit for patients undergoing uncomplicated ulnar nerve releases at the elbow. Preoperative antibiotics do not significantly decrease the risk for postoperative infections in patients, regardless of patient comorbidities.Type of Evidence: Level 4-retrospective study.