SLR - August 2014 - Alyssa Roskop

Surgical Site Infections After Arthroplasty: Comparative Effectiveness of Prophylactic Antibiotics

Reference: Ponce B, Raines BT, Reed RD, Vick C, Richman J, Hawn M. Surgical Site Infections After Arthroplasty: Comparative Effectiveness of Prophylactic Antibiotic: Do Surgical Care Improvement Project Guidelines Need to Be Updated? The Journal of Bone and Joint Surgery. 2014; 96:970-7.

Scientific Literature Review

Reviewed By: Alyssa Roskop
Residency Program: Southern Arizona VA Health Care System

Podiatric Relevance: Arthroplasty is a becoming a more common surgical procedure choice for joint disorders in the foot.

Methods: Patients undergoing elective hip or knee arthroplasty from 2005 to 2009 were eligible for inclusion in this retrospective cohort study from ninety-four Veterans Affairs hospitals. Exclusion occurred if patients had an ASA (American Society of Anesthesiologists) grade of five, had a wound classification other than clean, underwent emergency arthroplasty, partial hip arthroplasty, or revision arthroplasty. The independent variable of interest was the choice of prophylactic antibiotic, which included cefazolin, vancomycin, vancomycin plus cefazolin, and clindamycin. The dependent variable of interest was the occurrence of a superficial or deep incisional surgical site infection (SSI) within thirty days of surgery.

Results: A total of 18,830 elective primary arthroplasties (12,823 knee and 6007 hip) were included. Cefazolin only (81.9 percent) accounted for a majority of the patients, followed by vancomycin only (8 percent), vancomycin plus cefazolin (5.6 percent), and clindamycin (4.5 percent). A total of 264 SSIs (1.4 percent) were observed within thirty days of the arthroplasties. Vancomycin alone had the highest overall SSI rate at 2.3 percent followed by vancomycin plus cefazolin at 1.5 percent, cefazolin only at 1.3 percent, and clindamycin at 1.1 percent.

Conclusion: Results of the study suggest that SSI prophylaxis with vancomycin only is associated with a higher SSI rate.

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