Trends in extended oral antibiotic prophylaxis after primary total shoulder arthroplasty, 2010-2021

Abstract

Background

The absence of national guidelines on the use of extended oral antibiotic (EOA) prophylaxis has led to inconsistent use of EOA to prevent prosthetic joint infection after total shoulder arthroplasty (TSA). Our investigation aimed to determine temporal trends and prescription patterns in the use of EOA prophylaxis after TSA from 2010 to 2021, particularly for patients considered at high risk for infection.

Methods

Using the PearlDiver database, we identified 289,908 patients who underwent primary TSA from 2010 to 2021. EOA was defined as antibiotic use initiated before, during, or immediately after surgery and continued for 2 days or more postoperatively. Compounded annual growth rate and linear regression were used for trend analysis. Stratification measures were demographic variables, geographic location, insurance type, and risk factors for infection.

Results

Among primary TSA patients, 3.8% received EOA after TSA. Antibiotic use after TSA increased by a compounded annual growth rate of 6.2% from 2010 to 2021. Associations were observed between EOA prescription patterns and factors such as age, sex, Charlson Comorbidity Index value, geographic region, and insurance type. Cephalexin was the most frequently prescribed antibiotic, but prescriptions of cephalexin declined during the study period, while doxycycline prescriptions increased. Most patients received EOA for 2-7 days. Patients at high risk for infection, including those with diabetes, a history of tobacco use, chronic kidney disease, and autoimmune disorders, were more likely to receive EOAs compared to those without these factors.

Conclusion

This study provides insights into the dynamic landscape of EOA prophylaxis after TSA. The observed changes during the study period—namely, the increase in EOA prescriptions, demographic variation in prescription patterns, and shifting antibiotic preferences—highlight the evolving nature of clinical practice in the absence of standardized national guidelines. Continued research is needed to improve prophylactic strategies for patients with risk factors for infection. Surgeons can use this information to establish their own guidelines tailored to their patients, considering factors such as age, comorbid conditions, and regional practices, while closely monitoring for adverse effects and antibiotic resistance patterns.