Efficacy of perioperative antibiotic prophylaxis in elective soft-tissue-only wrist arthroscopy

Abstract

AimsWrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy.MethodsA clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained.ResultsThe overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms.ConclusionWe demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results.Cite this article: Bone Jt Open 2023;4(4):219–225.

Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis

“…observed 1.5% of adverse reactions after the preoperative single-dose administration of antibiotics to a cohort of 551 patients undergoing outpatient surgeries of the hand and upper limb [ 24 ]. According to Wachtel et al., one out of ten patients who receive antimicrobials show adverse reactions (16.2% versus 5.5%; p = 0.03) [ 22 ]. Likewise, a recent review described rates of up to 0.1% anaphylaxis due to the administration of cephalexin, as well as 21% diarrhea, and up to 8% infection caused by Clostridium difficile after the administration of clindamycin [ 10 ].…”

Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol

“…There is no consensus within the literature on the ideal management of hand and wrist trauma to reduce SSI. 19 , 21 - 25 The World Health Organization (WHO) have produced globally used guidelines to help prevent SSIs. 14 However, it is unclear what variability exists in the adherence to these guidelines within hand trauma surgery, which usually involves clean, contaminated, or dirty surgery depending on the injury.…”

Einsatz von Antibiotikum zur perioperativen Infektprophylaxe in der elektiven Handgelenksarthroskopie: Eine deutschlandweite Befragung

“…Darüber hinaus zeigten mehrere Studien, dass der Einsatz von PAP bei sauberen elektiven Weichteiloperatio-nen der Hand keinen Nutzen im Hinblick auf postoperative Wundinfektionen bietet[12,28]. Zumal in einer eigenen Studie eine dreifach höhere Rate an unerwünschten Arzneimittelwirkungen (UAW) bei Patienten mit HG-ASK (als reiner Weichteileingriff), welche eine PAP erhielten, festgestellt wurde[29]. Die PAP sollte daher kritisch indiziert werden, insbesondere bei HG-ASK ohne knöcherner Beteiligung.…”