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Antibiotic Prophylaxis in Clean Hand Surgery: A Prospective Cohort Analysis of Major and Minor Complications
Justin M Kistler1, Murty Munn1, Richard McEntee1
1Division of Hand and Wrist Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
Purpose:
The indications for prophylactic antibiotics in hand surgery remain undefined. Current literature has focused solely on readmission and reoperation for surgical site infection, while neglecting minor infectious complications treated at outpatient follow-up in addition to complications from antibiotic therapy observed after surgery. This study sought to analyze major and minor infection rates, as well as adverse effects of preoperative antibiotics after clean hand surgery.
Methods:
A prospective cohort study was conducted over a 6-month period. The cohorts included patients who received preoperative antibiotic prophylaxis and those that did not. Patient details and operative data were obtained during the first postoperative visit following the index surgery. Primary outcomes assessed were as follows: (1) major infection, defined as admission or reoperation for infection; (2) minor infection, defined as use of postoperative oral antibiotics; and (3) complications of antibiotic therapy.
Results:
A total of 377 consecutive patients underwent operations of the upper extremity. Complications from preoperative antibiotic therapy were seen in 6.9% of patients. Overall, there were no major postoperative infections and the minor postoperative infection rate was 5.6%. The minor infection rate was 6.9% (9/131) among patients who did not receive preoperative antibiotics and 4.9% (12/246) among patients who received preoperative antibiotics (P = .57).
Conclusions:
A 5.6% minor infection rate was identified following clean hand surgery, with no cases of major infection. Preoperative antibiotics did not demonstrate benefit in terms of reduction of minor infections, but they did yield a 6.9% adverse reaction rate, including one case of Clostridium difficile infection warranting hospitalization. Caution is recommended while prescribing prophylactic antibiotics for clean hand surgeries, given the lack of clear benefits and the potential for adverse effects.
Type Of Study/Level Of Evidence:
Prognostic II.
Insights
Prophylactic antibiotics in clean hand surgery show no benefit for minor infection rates and increase adverse effects. Caution is advised due to potential complications like Clostridium difficile infection.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pharmacology
Background:
- The role of prophylactic antibiotics in clean hand surgery is not well-defined.
- Existing research often overlooks minor infections and antibiotic-related complications.
Purpose of the Study:
- To evaluate major and minor infection rates after clean hand surgery.
- To assess adverse effects associated with preoperative antibiotic use.
Main Methods:
- A prospective cohort study involving 377 patients over 6 months.
- Comparison of outcomes between patients receiving and not receiving preoperative antibiotics.
- Assessment of major infections (hospitalization/reoperation), minor infections (oral antibiotics), and antibiotic complications.
Main Results:
- No major postoperative infections were observed.
- A 5.6% overall minor infection rate was recorded.
- Preoperative antibiotics did not significantly reduce minor infection rates (4.9% vs 6.9%) but caused a 6.9% complication rate, including C. difficile.
Conclusions:
- Preoperative antibiotics offer no clear advantage in preventing minor infections in clean hand surgery.
- A significant rate of adverse reactions to prophylactic antibiotics exists.
- Judicious use of prophylactic antibiotics is recommended for clean hand surgeries due to potential harm.
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