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Antibiotic Prophylaxis in Outpatient Elective Hand Surgery: a Retrospective Chart Review of 8,850 Cases
Sivak WN, Bykowski MR, Cray J, Buterbaugh G, Imbriglia JE, Lee WPA
University of Pittsburgh School of Medicine - Division of Plastic and Reconstructive Surgery
2010-03-29
Presenter: Sivak WN
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Hand
Hypothesis: The administration of preoperative antibiotic reduces surgical site infection (SSI) following clean, elective hand surgery.
Background: Prophylactic antibiotic use has been demonstrated to reduce SSI following general surgical procedures, but efficacy remains unclear in clean, elective hand surgery. Low patient number and low statistical power have limited prior attempts to define their use.
Methods: The database from an outpatient surgical center was queried by CPT code to identify patients who underwent elective hand surgery. For each of 8850 patient records the following were collected: demographics, co-morbidities, prophylactic antibiotic administration, and development of SSI.
Results: Overall SSI rate was 0.36% with an average patient follow-up time of 79 days. SSI rates did not significantly differ between patients receiving antibiotics (0.54%; 2,755 patients) and those who did not (0.26%; 6,095 patients). SSI was associated with smoking status (p=0.001; relative risk=3.1) and longer procedure length (p=0.003; 43.25 vs. 27.32 minutes = mean length of procedure for infection and non-infection group, respectively).
Conclusions: Prophylactic antibiotics did not effectively reduce SSI. Moreover, sub-group analysis revealed that antibiotics did not reduce the frequency of SSI among patients found to be at higher risk in this study. Given the harmful complications associated with antibiotic use and the lack of evidence that prophylactic antibiotics prevent SSI, we propose that antibiotics should not be routinely administered to patients who undergo clean, elective hand surgery in an outpatient center. To our knowledge, this case series represents the largest of its kind.
