Postoperative prophylactic and delayed oral antibiotics after total shoulder arthroplasty: a multi-institutional database analysis

To evaluate the effectiveness and safety of prophylactic and delayed postoperative oral antibiotics following total shoulder arthroplasty (TSA).

The TriNetX database was queried for primary TSA patients. Those with prior pathologic fracture, upper extremity malignancy, infection, prosthetic joint infection (PJI), or revision surgery within 6 months were excluded. After 1:1 propensity score matching, two comparisons were performed: (1) prophylactic oral antibiotics within 1 postoperative day versus controls (n=5,891 per cohort) and (2) delayed oral antibiotics on postoperative days 7-30 versus controls (n=3,087 per cohort). Outcomes at 30 and 90 days included acute kidney injury (AKI), emergency department (ED) visits, readmission, PJI, and revision surgery.

At 30 days, prophylactic antibiotics were associated with fewer readmissions (2.78% vs. 3.73%; P=0.004), with no differences in AKI, ED visits, PJI, or revision surgery. At 90 days, they were associated with higher PJI (0.92% vs. 0.48%; P=0.004) and a trend toward lower ED visits (5.25% vs. 6.16%; P=0.032) and readmissions (3.70% vs. 4.67%; P=0.009), but higher revision surgery (1.17% vs. 0.73%; P=0.014). Delayed antibiotics were associated with higher rates of AKI, ED visits, readmissions, and revision surgery at both 30 and 90 days (all P<0.001), as well as higher PJI at 90 days (3.14% vs. 0.42%; P<0.001).

Although residual confounding cannot be excluded, postoperative prophylactic or delayed oral antibiotics were not associated with reduced PJI or revision surgery and may be associated with antibiotic-related adverse effects. Level of evidence: III.