Of all post-operative complications, none is of greater concern than infection at the surgical site. While the use of antibiotics preoperatively can lower the post operative infection rate in elective bone and joint surgery, there is no evidence to support their continued use post operatively. It’s only when there is an established contaminated wound, such as with open fracture in a trauma situation, can post-operative antibiotics have a significant role. Because of the concern for infection there is a growing perception among surgeons, notably younger ones, that the routine use of pre-op antibiotics even in elective soft tissue surgery can make a difference but the scientific data does not support its use.
In a 2015 national study, it was determined that in aggregate the cost of this practice to the health care system was $1.6 million yearly.
This indiscriminate use of antibiotics is a known contributing factor in the development of multi-drug resistant bacteria especially in vulnerable hospital patients. The situation has been made worse by “administrative guidelines” put forth by hospital and regulatory agencies to “curb” post-op infections. These directives have been misinterpreted by many practitioners to prescribe these drugs needlessly.
In a recent study published in the Journal of Hand Surgery involving more than 300,000 patients, the infection rate for elective clean hand surgery was under 1% and the use of preoperative/postoperative antibiotics had no effect of the infection rate. Other studies have borne this out.
Despite the lack of evidence of necessity or efficacy, there is a significant growing trend by surgeons to recommend pre-op and even post-op antibiotics in clean elective soft tissue hand surgery such as in carpal tunnel and trigger finger release as well as the routine excision of ganglion cysts. These surgeries are performed in the U.S. hundreds of thousands times a year.
As consumers we need to question our health care providers as to the need for antibiotics in clean elective hand surgery.
Reference:
Johnson SJ, Zhong L, Chung KC, Waljee JF. Perioperative Antibiotics for Clean Hand Surgery: A National Study. Journal of Hand Surgery Am. 2018;43(5):407-416
