Meta-analysis of antibiotics for simple hand injuries requiring surgery

Murphy, Gardner; Gardiner, Matthew; Glass, Graeme E.; Kreis, Irene; Jain, Abhilash; Hettiaratchy, S

doi:10.1002/bjs.10111

Cited by 39 publications

(35 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In similar fashion, they found no significant reduction in SSI rate in patients who received antibiotic prophylaxis compared to placebo or no prophylaxis (RR 0.89, 95% CI 0.65 to 1.23, p=0.49%). 5 This finding was also maintained when restricting their meta-analysis to the higher quality five double-blind RCTs involving 864 patients (RR 0.66, 95% CI 0.36 to 1.21, p=0.18). 5 Perhaps, there are a subset of patients who would benefit from receiving peri-operative prophylactic antibiotics prior to their surgery, regardless of classification of degree of wound contamination.…”

Section: Discussionmentioning

confidence: 89%

“…More interestingly, their trend analysis highlighted a statistically significant progressive increase in the prescribing of peri-operative prophylactic antibiotics during that period in the aforementioned surgeries, except for trigger finger release (10.6% to 18.3%, p <0.001). 5 In light of these trends, there may be a need for large epidemiological studies to re-evaluate the incidence of SSI following clean non-prosthetic uncomplicated surgery. If infection rates are proven to be low as currently reported, then the overall effectiveness of current guidance and its implementation should be reviewed.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

“…They found no difference in the post-operative infection rates between the two groups. 5 A single-center retrospective review of 8,850 elective hand cases which also compared the use of pre-operative intravenous prophylactic antibiotics with no antibiotic prophylaxis did not find a significant difference in the incidence of SSI between the groups. 4 Despite this, there has been anecdotal evidence that pre-operative intravenous prophylactic antibiotics are currently being used prior to surgery for Dupuytren's disease.…”

mentioning

confidence: 93%

See 3 more Smart Citations

The Use of Prophylactic Antibiotics in Surgery for Dupuytren’s Disease: A Survey of Hand Surgeons

Kadhum

Sinclair

Middleton

2020

wjps

View full text Add to dashboard Cite

BACKGROUND National Institute for Health and Care Excellence (NICE) CG74 has set out evidence-based guidance on which types of surgery require antibiotic prophylaxis. Our aim was to establish what the current practice for antibiotic prophylaxis in Dupuytren's surgery is amongst hand surgeons in the United Kingdom, through the British Society for Surgery of the Hand (BSSH). METHODS Permission was granted for our online survey to be distributed to BSSH hand surgeons via consecutive BSSH e-bulletins. Hand surgeons who did not perform fasciectomy or dermofasciectomy were excluded from the study. RESULTS There were 64 respondents, represented an estimated 7.4-7.8% of membership. Eleven percent of respondents used antibiotics for fasciectomy, with an increasing trend towards revision surgery and dermofasciectomy. Over 30% prescribed them for revision dermofasciectomy. Dupuytren's surgery was classified as clean, non-prosthetic and uncomplicated which NICE CG74 suggestions did not require antibiotic prophylaxis. CONCLUSION This study highlighted variation in practice amongst hand surgeons in the United Kingdom. Further consultation to create guidelines for hand surgery may help guide members and reduce potentially unnecessary prophylactic antibiotic use.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

mentioning

confidence: 93%

See 2 more Smart Citations

The Use of Prophylactic Antibiotics in Surgery for Dupuytren’s Disease: A Survey of Hand Surgeons

Kadhum

Sinclair

Middleton

2020

wjps

View full text Add to dashboard Cite

show abstract

“…В настоящее время, несмотря на большие успехи хирургии, фармакологии, физиотерапии, осложнения со стороны хирургических ран различных органов и тканей продолжают оставаться довольно частым явлением [1][2][3]. В ряде случаев они могут стать причиной послеоперационной летальности [4][5][6][7].…”

unclassified

Optimization of tissue reparation at treatment by Remaxol

Vlasov

Zaitzcev

Власов

et al. 2017

Khir. Z. im. N.I. Pirogova

View full text Add to dashboard Cite

It is established that Remaxol optimizes the course of reparative process in laparotomy wound that was confirmed with data of tenziomety and wound exudate cytological research. Efficiency of a Remaxol is based on its capability to improve microcirculation, antiedematous action and its capability to reduce excessive intensity peroxide oxidation of membrane lipids, phospholipase activity and the phenomena of a hypoxia.

show abstract

Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions

Salcher-Konrad,

Nguyen,

Savović

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceRandomized clinical trials (RCTs) are widely regarded as the methodological benchmark for assessing clinical efficacy and safety of health interventions. There is growing interest in using nonrandomized studies to assess efficacy and safety of new drugs.ObjectiveTo determine how treatment effects for the same drug compare when evaluated in nonrandomized vs randomized studies.Data SourcesMeta-analyses published between 2009 and 2018 were identified in MEDLINE via PubMed and the Cochrane Database of Systematic Reviews. Data analysis was conducted from October 2019 to July 2024.Study SelectionMeta-analyses of pharmacological interventions were eligible for inclusion if both randomized and nonrandomized studies contributed to a single meta-analytic estimate.Data Extraction and SynthesisFor this meta-analysis using a meta-epidemiological framework, separate summary effect size estimates were calculated for nonrandomized and randomized studies within each meta-analysis using a random-effects model and then these estimates were compared. The reporting of this study followed the Guidelines for Reporting Meta-Epidemiological Methodology Research and relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcome and MeasuresThe primary outcome was discrepancies in treatment effects obtained from nonrandomized and randomized studies, as measured by the proportion of meta-analyses where the 2 study types disagreed about the direction or magnitude of effect, disagreed beyond chance about the effect size estimate, and the summary ratio of odds ratios (ROR) obtained from nonrandomized vs randomized studies combined across all meta-analyses.ResultsA total of 346 meta-analyses with 2746 studies were included. Statistical conclusions about drug benefits and harms were different for 130 of 346 meta-analyses (37.6%) when focusing solely on either nonrandomized or randomized studies. Disagreements were beyond chance for 54 meta-analyses (15.6%). Across all meta-analyses, there was no strong evidence of consistent differences in treatment effects obtained from nonrandomized vs randomized studies (summary ROR, 0.95; 95% credible interval [CrI], 0.89-1.02). Compared with experimental nonrandomized studies, randomized studies produced on average a 19% smaller treatment effect (ROR, 0.81; 95% CrI, 0.68-0.97). There was increased heterogeneity in effect size estimates obtained from nonrandomized compared with randomized studies.Conclusions and RelevanceIn this meta-analysis of treatment effects of pharmacological interventions obtained from randomized and nonrandomized studies, there was no overall difference in effect size estimates between study types on average, but nonrandomized studies both overestimated and underestimated treatment effects observed in randomized studies and introduced additional uncertainty. These findings suggest that relying on nonrandomized studies as substitutes for RCTs may introduce additional uncertainty about the therapeutic effects of new drugs.

show abstract

Meta-analysis of antibiotics for simple hand injuries requiring surgery

Abstract: There was moderate-quality evidence that routine use of antibiotics does not reduce the infection rate in simple hand wounds that require surgery.

Cited by 39 publications

References 30 publications

The Use of Prophylactic Antibiotics in Surgery for Dupuytren’s Disease: A Survey of Hand Surgeons

The Use of Prophylactic Antibiotics in Surgery for Dupuytren’s Disease: A Survey of Hand Surgeons

Optimization of tissue reparation at treatment by Remaxol

Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions

Contact Info

Product

Resources

About