Foregoing Preoperative Antibiotics in Clean, Implant-Based Hand Surgery Does Not Increase Postoperative Infectious Risks.

Purpose: Although data support foregoing preoperative antibiotics for outpatient, soft-tissue procedures, there is a paucity of evidence regarding antibiotics for implant-based hand procedures. The purpose of this investigation was to assess early postoperative infectious concerns for patients undergoing implant-based hand surgery, regardless of preoperative antibiotic use. Methods: A retrospective cohort analysis was performed consisting of all patients undergoing implant-based hand procedures between January 2015 and October 2021. Primary outcomes included antibiotic prescription or reoperation for infection within 90 days of surgery. Demographics (age, gender, body mass index, diabetes, and smoking status) and hand surgery procedure type were recorded. To account for differences in baseline characteristics between patients who did and did not receive preoperative antibiotics, covariate balancing was performed with subsequent weighted logistic regression models constructed to estimate the effect of no receipt of preoperative antibiotics on the need for postoperative antibiotics. In a separate logistic regression analysis, patients' baseline characteristics were evaluated together as predictors of postoperative antibiotic prescription. Results: One thousand eight hundred sixty-two unique procedures were reviewed with 1,394 meeting criteria. Two hundred thirty-six patients (16.9%) were not prescribed preoperative antibiotics. Overall, 54 (3.87%) and 69 (4.95%) patients received antibiotics within 30 and 90 days of surgery, respectively. One patient (0.07%) underwent reoperation. There were no differences in the rates of 30- and 90-day postoperative antibiotic prescriptions between the two groups. After covariant balancing of risk factors, patients not prescribed preoperative antibiotics did not display significantly higher odds of requiring postoperative antibiotics at 30 or 90 days. Logistic regression models showed male gender, temporary Kirschner wire fixation, and elevated body mass index were associated with increased postoperative antibiotics at 30 and 90 days. Conclusions: For implant-based hand procedures, there was no increased risk in postoperative antibiotic prescription or reoperation for patients who did not receive preoperative antibiotics. Type of study/level of evidence: Therapeutic III.