ArticleShoulder & elbow2026
Extended oral antibiotic prophylaxis does not reduce periprosthetic joint infection after primary outpatient total shoulder arthroplasty: A matched cohort analysis.
Article in Shoulder & elbow, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Over the last decade, total shoulder arthroplasty (TSA) has increasingly transitioned to the outpatient setting, where postoperative care pathways inherently limit the ability to deliver a full 24 hour course of intravenous antibiotic prophylaxis. Despite guideline recommendations, extended oral antibiotic prophylaxis is variably used after outpatient TSA, with limited evidence supporting this practice. Methods: A retrospective cohort study using the TriNetX database identified patients undergoing primary outpatient TSA between 2015 and 2025. Patients were stratified by receipt of extended oral antibiotic prophylaxis. Propensity score matching yielded two cohorts of 2647 patients each. Outcomes included periprosthetic joint infection (PJI), surgical site infection (SSI), all-cause revision, wound disruption, and emergency department utilization at 90 days and 1 year. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: At 90 days, there were no significant differences in PJI (0.9% vs 0.5%; RR 1.20, 95% CI 0.96-3.84) or SSI (0.8% vs 0.5%; RR 1.67, 95% CI 0.82-3.40). At 1 year, PJI (1.6% vs 1.2%; RR 1.34, 95% CI 0.85-2.12) and SSI (1.1% vs 0.8%; RR 1.14, 95% CI 0.79-2.42) rates remained comparable between groups. Discussion: Extended oral antibiotic prophylaxis did not reduce infection-related outcomes following primary outpatient TSA. Level of evidence: III, Retrospective cohort study.
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