Harness Neil G, Inacio Maria C, Pfeil Faith F, Paxton Liz W
Department of Orthopedic Surgery, Southern California Permanente Medical Group, Kaiser Anaheim Medical Center, Anaheim, CA 92806, USA.
J Hand Surg Am. 2010 Feb;35(2):189-96. doi: 10.1016/j.jhsa.2009.11.012.
To determine the rate of postoperative wound infection and the association with prophylactic antibiotic use in uncomplicated carpal tunnel release surgery.
We performed a multicenter, retrospective review of all the carpal tunnel release procedures performed between January 1, 2005, and August 30, 2007. Data reviewed included the use of prophylactic antibiotics, diabetic status, and the occurrence of postoperative wound infection. We determined the overall antibiotic usage rate and analyzed the correlation between antibiotic use and the development of postoperative wound infection.
The rate of surgical site infections in the 3003 patients who underwent carpal tunnel release surgery (group A) was 11. Antibiotic usage data were available for 2336 patients (group B). Six patients without prophylactic antibiotics had infection, as did 5 patients with prophylactic antibiotics. This difference was not statistically significant. Of the 11 surgical site infections, 4 were deep (organ/space) and 7 superficial (incisional). The number of patients with diabetes in the overall study population was 546, 3 of whom had infections. This was not statistically different from the nondiabetic population infection rate (8 patients).
The overall infection rate after carpal tunnel release surgery is low. In addition, the deep (organ/space) infection rate is much lower than previously reported. Antibiotic use did not decrease the risk of infection in this study population, including patients with diabetes. The routine use of antibiotic prophylaxis in carpal tunnel release surgery is not indicated. Surgeons should carefully consider the risks and benefits of routinely using prophylactic antibiotics in carpal tunnel release surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
确定单纯性腕管松解手术的术后伤口感染率及其与预防性使用抗生素的关系。
我们对2005年1月1日至2007年8月30日期间进行的所有腕管松解手术进行了多中心回顾性研究。回顾的数据包括预防性抗生素的使用、糖尿病状态以及术后伤口感染的发生情况。我们确定了总体抗生素使用率，并分析了抗生素使用与术后伤口感染发生之间的相关性。
3003例行腕管松解手术的患者（A组）手术部位感染率为11%。2336例患者（B组）有抗生素使用数据。6例未使用预防性抗生素的患者发生感染，5例使用预防性抗生素的患者也发生感染。这种差异无统计学意义。在11例手术部位感染中，4例为深部（器官/腔隙）感染，7例为浅表（切口）感染。整个研究人群中糖尿病患者有546例，其中3例发生感染。这与非糖尿病人群感染率（8例）无统计学差异。
腕管松解手术后总体感染率较低。此外，深部（器官/腔隙）感染率远低于先前报道。在本研究人群中，包括糖尿病患者，使用抗生素并未降低感染风险。不建议在腕管松解手术中常规使用抗生素预防。外科医生应仔细考虑在腕管松解手术中常规使用预防性抗生素的风险和益处。
研究类型/证据水平：治疗性III级。
