1
|
Lachance AD, Giro ME, Edelstein A, Klos E, Lee W. Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery? FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231224796. [PMID: 38288286 PMCID: PMC10823856 DOI: 10.1177/24730114231224796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Background Previous studies about antibiotic prophylaxis in foot and ankle surgery have focused on perioperative intravenous administration, with few studies reporting on the efficiency of postoperative oral antibiotics. The purpose of this study is to investigate differences in the rate of postoperative infection and wound complications between patients with and without postoperative oral antibiotics and to identify independent risk factors for these complications following foot and ankle surgeries. Methods A retrospective review of all elective foot and ankle surgeries with at least a 6-month follow-up was performed over a 2-year time span. Patients were divided into 2 groups based on if they received postoperative oral antibiotics. We compared the rates of postoperative infections and wound complications between the 2 groups. The surgical site, the number of Current Procedural Terminology codes, and the number of surgical incisions were also noted. Multivariable logistic regression analysis was performed to identify independent risk factors of postoperative infection and wound complications. Results A total of 366 patients were included in this study-240 with antibiotics and 126 without antibiotics. There was no significant difference in the rates of postoperative infection and wound complications between the 2 groups. The rate of superficial infection, deep infection, and wound complications was 1.7%, 0.8%, and 5.8% in the antibiotic group vs 3.2%, 0.0%, and 4.0% in patients without antibiotics, respectively. Multivariable logistic regression analysis identified independent risk factors of postoperative infection and wound complications as follows: smoking (OR: 4.7), male (OR: 4.0), history of neoplasm (OR: 6.7), and multiple incisions (OR: 4.1). Conclusion Our results suggest that routine postoperative prophylactic oral antibiotics are not needed following elective foot and ankle surgeries. However, certain risk factors may increase the risk for postoperative infection and wound complications in foot and ankle surgery. Level of Evidence Level III, case-control study.
Collapse
Affiliation(s)
| | - Margaret E. Giro
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | | | - Eliza Klos
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| |
Collapse
|
2
|
Meng J, Zhu Y, Li Y, Sun T, Zhang F, Qin S, Zhao H. Incidence and risk factors for surgical site infection following elective foot and ankle surgery: a retrospective study. J Orthop Surg Res 2020; 15:449. [PMID: 33004062 PMCID: PMC7528469 DOI: 10.1186/s13018-020-01972-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 09/23/2020] [Indexed: 01/23/2023] Open
Abstract
Background This study aimed to investigate the incidence of surgical site infection (SSI) in elective foot and ankle surgeries and identify the associated risk factors. Methods This was designed as a retrospective study, including patients who underwent elective surgery of foot and ankle between July 2015 and June 2018. Data on demographics, comorbidities, and perioperative parameters were collected from the medical records, the laboratory report, the operation report, and the outpatient follow-up registration database. SSI was defined in accordance with the Center for Disease Control criteria. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for SSI. Results A total of 1201 patients undergoing 1259 elective foot/ankle surgeries were included, of whom 26 (2.1%) had an SSI, representing an incidence rate of 1.3% for superficial SSI and 0.8% for deep SSI, respectively. The results for organism culture showed Pseudomonas aeruginosa in 7 cases, methicillin-resistant Staphylococcus aureus (MRSA) in 6, methicillin-susceptible Staphylococcus aureus (MSSA) in 5, methicillin-resistant coagulase-negative Staphylococci (MRCNS) in 2, Escherichia coli in 2, and Proteus mirabilis in 1 case. Five factors were identified to be independently associated with SSI, including prolonged preoperative stay (OR, 1.21; 95% CI, 1.09 to 1.30), allograft or bone substitute (OR, 3.76; 95% CI, 1.51 to 5.30), elevated FBG level (OR, 1.17; 95% CI, 1.04 to 1.26), lower ALB level (OR, 2.33; 95% CI, 1.19 to 3.05), and abnormal NEUT count (OR, 1.72; 95% CI, 1.27 to 2.12). Conclusions SSI following elective foot and ankle surgeries is low, but relatively high in forefoot surgeries, requiring particular attention in clinical practice. Although most not modifiable, these identified factors aid in risk assessment of SSI and accordingly stratifying patients and therefore should be kept in mind.
Collapse
Affiliation(s)
- Jinghong Meng
- Department of Rheumatology and Immunology, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Trauma Center, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yansen Li
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tao Sun
- Department of Bone Tumor, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fengqi Zhang
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Shiji Qin
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Haitao Zhao
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
3
|
Modha MRK, Morriss-Roberts C, Smither M, Larholt J, Reilly I. Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature. J Foot Ankle Res 2018; 11:61. [PMID: 30479666 PMCID: PMC6238341 DOI: 10.1186/s13047-018-0303-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/24/2018] [Indexed: 01/08/2023] Open
Abstract
Background With the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines. Methodology A systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle. Results Overall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed. Conclusion Whilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.
Collapse
Affiliation(s)
- Mr Ravi Krishān Modha
- Department of Podiatric Surgery, Ilkeston Hospital, Heanor Road, Ilkeston, Heanor, DE7 8LN UK
| | - Chris Morriss-Roberts
- Department of Podiatric Surgery, Ilkeston Hospital, Heanor Road, Ilkeston, Heanor, DE7 8LN UK
| | - Madeleine Smither
- Department of Podiatric Surgery, Ilkeston Hospital, Heanor Road, Ilkeston, Heanor, DE7 8LN UK
| | - Jonathan Larholt
- Department of Podiatric Surgery, Ilkeston Hospital, Heanor Road, Ilkeston, Heanor, DE7 8LN UK
| | - Ian Reilly
- Department of Podiatric Surgery, Ilkeston Hospital, Heanor Road, Ilkeston, Heanor, DE7 8LN UK
| |
Collapse
|
4
|
Matthews JH, Terrill AJ, Barwick AL, Butterworth PA. Venous Thromboembolism in Podiatric Foot and Ankle Surgery. Foot Ankle Spec 2018; 11:444-450. [PMID: 29338332 DOI: 10.1177/1938640017750256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The extent to which podiatric surgeons follow venous thromboembolism guidelines is unknown. The aim of this study therefore, was 2-fold: (a) to determine the rate of venous thromboembolism following podiatric surgery and (b) to investigate the factors that influence the use of thromboprophylaxis. METHODS Data from 4238 patients who underwent foot and ankle surgery over 2 years were analyzed. Venous thromboembolism within the first 30 days following surgery was recorded using the Australasian College of Podiatric Surgeons surgical audit tool. Logistic regression analyses were undertaken to determine the factors that influenced thromboprophylaxis. RESULTS Of the 4238 patient records, 3677 records (87%) provided complete data (age range 2-94 years; mean ± SD, 49.1 ± 19.7 years; 2693 females). A total of 7 venous thromboembolic events (0.2% rate) were reported. Operative duration and age (OR 12.63, 95% CI 9.47 to 16.84, P < 0.01), postoperative immobilization (OR 6.94, 95% CI 3.95 to 12.20, P < 0.01), and a prior history of VTE (OR 3.41, 95% CI 1.01 to 11.04, P = 0.04) were the strongest predictors of thromboprophylaxis. CONCLUSION Podiatric foot and ankle surgery is associated with a low rate of venous thromboembolism. This may be due in part to the thromboprophylaxis regime implemented by podiatric surgeons, which closely aligns with current evidence-based guidelines. LEVELS OF EVIDENCE Level II: Prospective cohort study.
Collapse
Affiliation(s)
- Jemma H Matthews
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| | - Alexander J Terrill
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| | - Alex L Barwick
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| | - Paul A Butterworth
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| |
Collapse
|
5
|
Application of antimicrobial drugs in perioperative surgical incision. Ann Clin Microbiol Antimicrob 2018; 17:2. [PMID: 29397046 PMCID: PMC5797388 DOI: 10.1186/s12941-018-0254-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 01/10/2023] Open
Abstract
Infection in surgical incision often results in poor wound healing, and one of the main factors for wound infection is the use of antimicrobial agents. Rational use of antibiotics is one of the key factors to prevent incision infection in general surgery. The number of current clinical studies on antibiotic use before and during surgery is greater than that of systematic studies on antibiotic use after surgery. For the rational use of antibiotics and improvement of wound healing rate, researchers around the world have gradually focused on the use of antibiotics after surgery. Despite the familiarity on the concept of “rational use of antibiotics”, few clear and systematic studies were conducted to elucidate the effect of different antibiotics on wound healing. Therefore, this review focuses on the use of different types of antimicrobial agents in surgical wounds.
Collapse
|