Does Perioperative Antibiotic Administration Decrease the Incidence of Prosthetic Joint Infection in Patients Undergoing Elective Soft Tissue Hand Surgery?

Abstract

Purpose

The use of prophylactic antibiotics in patients with existing total hip or knee arthroplasty undergoing elective hand surgery has not been studied. We tested the null hypothesis that perioperative antibiotic administration is not associated with the incidence of prosthetic joint infection (PJI) in patients undergoing elective, soft tissue hand surgery.

Methods

We used a large, national administrative claims database to identify patients with existing total hip or knee arthroplasty undergoing soft tissue hand surgery (carpal tunnel release, de Quervain release, trigger finger release, limited palmar fasciectomy, ganglion or mucoid cyst removal, or soft tissue mass removal). Antibiotic prophylaxis was defined as the same day administration of intravenous cefazolin, vancomycin, or clindamycin. Patients receiving antibiotics were propensity score-matched in a 1:1 ratio to those who did not, accounting for age, sex, geographic region, insurance plan, subsequent surgeries, and the presence of comorbid diabetes mellitus, rheumatoid arthritis, myocardial infarction, congestive heart failure, chronic kidney disease, human immunodeficiency virus infection, chronic kidney disease, malignancy, obesity, or tobacco use. Residual differences between matched cohorts were adjusted for using multivariable logistic regression. The primary outcome was the incidence of PJI within 6, 9, and 12 months after hand surgery.

Results

The overall incidence of PJI was 0.8% (166/21,582) within 12 months after hand surgery. There was no difference in the incidence of PJI between patients who received antibiotic prophylaxis and those who did not at 6 (0.3% vs 0.5%), 9 (0.6% vs 0.7%), or 12 months (0.7% vs 0.8%) after hand surgery. These findings were unchanged after adjusting for residual confounding. Surgical site infection within 3 months after hand surgery was also not associated with PJI at 6, 9, or 12 months.

Conclusions

We found no association between prophylactic antibiotic administration in patients with prior total hip or knee arthroplasty undergoing soft tissue hand surgery and the incidence of PJI at 6, 9, and 12 months after surgery.

Type of study/level of evidence

Prognostic II.