The Impact of Clinical Practice Guidelines on Preoperative Antibiotic Administration for Carpal Tunnel Release. Hand (N Y) 2023 Jul;18(5):780-784
Date
01/08/2022Pubmed ID
34991355Pubmed Central ID
PMC10336808DOI
10.1177/15589447211063543Scopus ID
2-s2.0-85122758959 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
Background: In 2015, the American Association of Plastic Surgeons (AAPS) published a consensus statement against the routine use of preoperative antibiotic prophylaxis to prevent surgical site infection in clean hand surgery. The American Academy of Orthopaedic Surgeons (AAOS) similarly cited "insufficient evidence" in its Appropriate Use Criteria guidelines to support the use of antibiotics in carpal tunnel surgery. Nonetheless, its administration remains a common practice during clean hand surgery. We sought to evaluate the impact of the above guidelines on preoperative antibiotic administration. Methods: An institutional review board-approved retrospective chart review of consecutive patients with carpal tunnel syndrome treated with open carpal tunnel release (CTR) at our institution was performed in the 2 years before and after publication of AAPS/AAOS guidelines. Patient demographics and surgical outcomes were reviewed. Incidence of antibiotic administration, patient demographics, and surgeon factors were collected. Results: A total of 770 primary open CTR procedures were performed in the studied years. In 2013 and 2014, 83.9% of patients received preoperative antibiotics. In 2017 and 2018, 48.2% of patients received preoperative antibiotics. Of the variables analyzed, immunosuppression, history of diabetes, and poorly controlled diabetes (A1c > 7) were found to be statistically significant in its positive correlation to prophylactic preoperative antibiotic use. Diabetes was not associated with surgical site infections. Conclusion: Patients were more likely to receive preoperative antibiotics before the publication of the AAPS/AAOS clinical practice guidelines. Patients with diabetes regardless of their glycemic control are more likely to receive preoperative antibiotics.
Author List
Mehta S, Court T, Graf A, Best C, Havlik RAuthors
Alexander Reed Graf MD Assistant Professor in the Orthopaedic Surgery department at Medical College of WisconsinRobert Havlik MD Chair, Professor in the Plastic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Anti-Bacterial AgentsAntibiotic Prophylaxis
Carpal Tunnel Syndrome
Humans
Orthopedics
Practice Guidelines as Topic
Retrospective Studies
United States
