Hoel Ryan J, Mittelsteadt Marcus J, Samborski S Andrew, Bohn Deborah C
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Department of Orthopaedics, University of Rochester, Rochester, NY.
J Hand Surg Am. 2018 Nov;43(11):987-991.e1. doi: 10.1016/j.jhsa.2018.03.040. Epub 2018 May 16.
This study seeks to evaluate the need for preoperative antibiotics for wrist arthroscopy.
A retrospective review of 576 consecutive wrist arthroscopies was performed over a 10-year period at a single ambulatory surgery center. The chart of each included patient was reviewed for postoperative infections following the National Nosocomial Infections Surveillance criteria for diagnosis.
Of the 576 wrist arthroscopies reviewed, 324 met the inclusion criteria. Preoperative antibiotics were administered in 209 cases (65%) and not administered in 115 cases (35%). There were 116 cases (36%) with concomitant open soft tissue procedures. We identified 2 infections (0.6% overall infection rate), both of which were in patients who had received preoperative antibiotics. Both of these patients underwent concomitant percutaneous pinning of carpal bones with Kirschner wires, which were buried beneath the skin.
Administering preoperative antibiotics for routine wrist arthroscopy does not appear to lower the surgical site infection rate. The rate of surgical site infection is so low in both cohorts that a meaningful difference cannot be determined between the 2 groups. This study adds to the current body of literature suggesting that it is acceptable practice to withhold preoperative antibiotics for surgeries that have a very low rate of infection.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在评估腕关节镜手术术前使用抗生素的必要性。
在一个门诊手术中心，对10年间连续进行的576例腕关节镜手术进行回顾性研究。根据国家医院感染监测诊断标准，对纳入研究的每位患者的病历进行术后感染情况审查。
在审查的576例腕关节镜手术中，324例符合纳入标准。209例（65%）患者术前使用了抗生素，115例（35%）未使用。116例（36%）患者同时进行了开放性软组织手术。我们发现2例感染（总感染率0.6%），均发生在术前使用抗生素的患者中。这两名患者均同时接受了克氏针经皮固定腕骨手术，克氏针埋于皮下。
常规腕关节镜手术术前使用抗生素似乎并未降低手术部位感染率。两组的手术部位感染率都很低，无法确定两组之间存在有意义的差异。本研究为现有文献增添了内容，表明对于感染率极低的手术，不使用术前抗生素是可接受的做法。
研究类型/证据水平：治疗性IV级。
