Article

Rate of infection after carpal tunnel release surgery and effect of antibiotic prophylaxis.

Department of Orthopedic Surgery, Southern California Permanente Medical Group, Kaiser Anaheim Medical Center, Anaheim, CA 92806, USA.
The Journal of hand surgery (impact factor: 1.33). 02/2010; 35(2):189-96. DOI:10.1016/j.jhsa.2009.11.012 pp.189-96
Source: PubMed

ABSTRACT 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.
Therapeutic III.

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    Article: Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery.
    Martin R Leblanc, Donald H Lalonde, Achilleas Thoma, Mike Bell, Neil Wells, Murray Allen, Peter Chang, Daniel McKee, Jan Lalonde
    [show abstract] [hide abstract]
    ABSTRACT: Over 70% of Canadian carpal tunnel syndrome (CTS) operations are performed outside of the main operating room (OR) with field sterility and surgeon-administered pure local anesthesia [LeBlanc et al., Hand 2(4):173-8, 14]. Is main OR sterility necessary to avoid infection for this operation? This study evaluates the infection rate in carpal tunnel release (CTR) using minor procedure room field sterility. This is a multicenter prospective study reporting the rate of infection in CTR performed in minor procedure room setting using field sterility. Field sterility means prepping of the hand with iodine or chlorhexidine, equivalent of a single drape, and a sterile tray with modest instruments. Sterile gloves and masks are used, but surgeons are not gowned. No prophylactic antibiotics are given. One thousand five hundred four consecutive CTS cases were collected from January 2008 to January 2010. Six superficial infections were reported and four of those patients received oral antibiotics. No deep postoperative wound infection was encountered, and no patient required admission to hospital, incision and drainage, or intravenous antibiotics. A superficial infection rate of 0.4% and a deep infection rate of 0% following CTR using field sterility confirm the low incidence of postoperative wound infection using field sterility. This supports the safety and low incidence of postoperative wound infection in CTR using minor procedure field sterility without prophylactic antibiotics. The higher monetary and environmental costs of main OR sterility are not justified on the basis of infection for CTR cases.
    Hand 03/2011; 6(1):60-3.
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Keywords

11 surgical site infections
 
5 patients
 
8 patients
 
antibiotic prophylaxis
 
Antibiotic usage data
 
antibiotic usage rate
 
antibiotic use
 
August 30
 
carpal tunnel release procedures
 
carpal tunnel release surgery
 
diabetic status
 
nondiabetic population infection rate
 
postoperative wound infection
 
prophylactic antibiotic use
 
prophylactic antibiotics
 
routine use
 
study population
 
surgical site infections
 
Therapeutic III
 
uncomplicated carpal tunnel release surgery