Perioperative Prophylactic Antibiotics and Endoscopic Carpal Tunnel Release

PURPOSE: Carpal tunnel release (CTR) represents 90% of all surgically treated compression neuropathies, with around 500,000 procedures performed annually in the United States. Of these, roughly 25% are done endoscopically. Surgical site infections (SSIs) after CTR are rare, occurring in up to 1% of patients. Guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Plastic Surgeons (AAPS) do not recommend perioperative prophylactic antibiotics for SSI prevention in CTR. Despite these guidelines, perioperative prophylactic antibiotics are still regularly used in CTR patients. Although the current guidelines are based upon a broad body of evidence, some of the current literature is limited by small cohort sizes, which highlights the need for further evaluation of this topic. Given this population's size, evaluating the necessity of perioperative prophylactic antibiotics is important for reducing antimicrobial resistance, lowering health care costs, and preventing antibiotic-associated adverse events. This study's aim is to compare the risk of SSIs after endoscopic CTR in large cohorts of patients who did and did not receive perioperative prophylactic antibiotics. METHODS: A retrospective cohort study was conducted using the TriNetX Research Network. The cohorts contained adult patients who underwent endoscopic CTR with or without perioperative antibiotic exposure. Cohorts were then 1:1 propensity-matched, and measures of association analyses were run that calculated and compared the cohorts' risk of SSI in the thirty days postoperatively. RESULTS: There was no statistically significant difference in superficial SSI risk between the cohorts with and without perioperative antibiotic prophylaxis (risk difference=0, 95% CI=0, 0, Z=0.47, P=0.638). CONCLUSIONS: Consistent with current AAPS and AAOS clinical guidelines, there is no increased risk of superficial SSIs for individuals who do not receive perioperative prophylactic antibiotics for endoscopic CTR.