The Use of Pre-Operative Antibiotics in Hardware-Based Hand Procedures is Not Necessary: A Single Surgeon Experience
Emma S Dahmus, MD, MBA1; Glen Jacob, MD1
1Geisinger Wyoming Valley
BACKGROUND: A recent survey to ASSH members by Dunn et al showed that the use of pre-operative antibiotics was random and not standardized for all hand procedures. Data support not prescribing pre-operative antibiotics for clean, outpatient, soft-tissue procedures. There is minimal evidence for hardware-based hand procedures regarding the need for pre-operative antibiotics. The literature that supports the need for pre-operative antibiotics comes from large joint procedures, not hand procedures. Hand infections can be devastating, but antibiotic use carries its own risks, including allergies, resistance and C.diff infections. The purpose of our study is to compare infectious outcomes for patients undergoing hardware-based hand surgery between those who did and did not receive pre-operative antibiotics.
METHODS: A retrospective cohort analysis was performed on hardware-based surgical patients from the senior authorís hand practice between January 2015 to October 2021. All patients either received permanent hardware or percutaneous K-wire fixation. Exclusion criteria included polytrauma patients, patients with open hand wounds, and patients with less than two outpatient follow-up visits. Primary outcomes measured were 30- and 90-day prescribed antibiotics for surgical-site specific concerns and need to return to the operating room. Basic demographic information such as age, sex, BMI, diabetes diagnosis and smoking status were recorded and compared.
RESULTS: 472 patients were reviewed, with 365 patients meeting inclusion and exclusion criteria. 220 patients did not receive pre-operative antibiotics and 145 patients did receive pre-operative antibiotics. Chi-squared tests was utilized to analyze for associations between the variables. For surgical-site specific concerns, 13 patients in the non-antibiotic group received a post-operative antibiotic prescription within 30 days, compared to 5 patients in the antibiotic group (p=0.415). 16 patients in the non-antibiotic group received a post-operative antibiotic prescription within 90 days, compared to 8 patients in the antibiotic group (p=0.655). One patient in the non-antibiotic group required return to the operating room for irrigation and debridement.
CONCLUSION: There is no significant difference for 30- or 90-day post-operative antibiotic prescriptions between those who did and did not receive pre-operative antibiotics based on this single surgeon experience.
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