SLR - July 2023 - Spencer R. Arndt, DPM
Title: Postoperative Infection and Revision Surgery Rates in Foot and Ankle Surgery Without Routine Prescription of Prophylactic AntibioticsReference: Huang N, Miles DT, Read CR, White CC, Murray RD, Wilson AW, Doty JF. Postoperative Infection and Revision Surgery Rates in Foot and Ankle Surgery Without Routine Prescription of Prophylactic Antibiotics. J Am Acad Orthop Surg Glob Res Rev. 2023 Mar 8;7(3)
Level of Evidence: 3 – Retrospective review
Scientific Literature Review
Reviewed By: Spencer R. Arndt, DPM
Residency Program: Regions Hospital, Saint Paul Minnesota
Podiatric Relevance:
Surgical site infections are associated with increased patient morbidity and increased healthcare costs. There is currently no guideline present to suggest when prophylactic antibiotics should be used in outpatient foot and ankle surgery to decrease the risk of surgical site infection. With a growing movement towards antibiotic stewardship, avoiding the use of prophylactic antibiotics would help decrease risks of increasing more antibiotic-resistant organisms. This study retrospectively examined outpatient foot and ankle surgery and the incidence of postoperative infection in these surgeries. This study also examined risk factors for patient that increases their chance of developing a postoperative infection.
Methods:
This was a retrospective review of 1685 patient is who underwent outpatient surgery with a single surgeon over a 4-year period from 2017 to 2020. Exclusion criteria this population included patient who were admitted to the hospital for 23-hour observation, inpatient stays, and patient who were having a procedure for pre-existing infection. All of the patients were given ancef or vancomycin perioperatively. None of the patient's received any prophylactic antibiotic postoperatively. 1517 of the 1685 patient has met the criteria and were included in the study.
Results:
Of the 1517 patients, 30 patients were diagnosed with simple superficial infection and 14 patients required returning to the operating room because of postoperative deep infection. 29 of the 30 superficial infection patients were treated with antibiotics consisting either of Bactrim or Clindamycin and were all resolved, the remaining superficial infection resolved without antibiotics. The average time to return to the operating room for the 14 patients with deep infection was 77 days. Patient age greater than 40 accounted for 38 of the total 44 postoperative infections which shows the significance of age. 11 of the total 44 patients had diabetes which was found to be the most significant risk factor based on univariate and multivariate analyses.
Conclusions:
The researchers identified increasing age and diabetes as the most significant risk factors for developing surgical site infections. They also speculated about the potential benefits of prophylactic antibiotics in older populations due to their higher susceptibility to superficial infections. However, they cautioned against this approach, highlighting the significant risk of developing opportunistic infections associated with antibiotic use. The study's strengths included a substantial sample size over a 4-year period and the involvement of an experienced surgeon. Additionally, a wide range of elective outpatient foot and ankle procedures were included, enhancing the applicability of the findings. On the other hand, the study had certain weaknesses including that there was no control group available for comparison purposes. In conclusion, the authors observed that outpatient foot and ankle surgery lead to acceptable postoperative surgical site infection incidence without the routine use of prophylactic antibiotics.