Research paper
The use of prophylactic antibiotics in podiatric foot and ankle surgery

https://doi.org/10.1016/j.idh.2017.01.002Get rights and content

Highlights

  • •

    The use of prophylactic antibiotic therapy has not been evaluated in the Australian podiatry community.

  • •

    Surgeon experience may influence infection rates in podiatric foot and ankle surgical practice.

  • •

    Perioperative antibiotics may reduce the risk of infection, however the use or addition of postoperative antibiotics does not.

Abstract

Objective

Infection is a common and serious complication following surgery. Whether antibiotic prophylaxis reduces infection rates in podiatric foot and ankle surgery is unclear. The aim of this prospective cohort study therefore, was to determine the impact of antibiotic use on infection rates following podiatric foot and ankle surgery.

Methods

Data from 4238 patients who underwent foot and ankle surgery between January 2014 and January 2016 were analysed. Infections within the first 30 days following surgery were recorded according to the Australasian College of Podiatric Surgeons national audit descriptors. Logistic regression analyses were undertaken to determine whether antibiotic prophylaxis decreased the rate of surgical site infection.

Results

Of the 4238 patient records, 4140 records (98%) provided complete data (aged 2–92 years, mean 48.9 ± SD 19.6, 1124 males, and 3016 females). A total of 79 infections (1.9% infection rate) were reported. More experienced surgeons documented a lower rate of infection (OR 0.36, 95% CI 0.17–0.72, P < 0.01) and the use of perioperative antibiotics was associated with lower infection rates than those that received no antibiotics (OR 0.42, 95% CI 0.22–0.81, P = 0.01). There was no significant association found between age, sex, and ASA score with infection. The use of postoperative antibiotics alone and in addition to perioperative antibiotics was not associated with reduced surgical site infection rates.

Conclusion

Surgeon experience may influence infection rates in podiatric foot and ankle surgical practice, and the use of perioperative antibiotics may reduce the risk of infection. The use or addition of postoperative antibiotics does not reduce infection rates, and should be used by podiatric surgeons with caution.

Introduction

Infection is the most frequent and costly complication of elective surgical procedures [1]. Surgical site infections (SSI) can result in permanent disability, reduced quality of life [2], and increased mortality rates [3]. Such infections also increase the use and cost of health care services [4]. In Australia, infection within 30 days following joint arthroplasty contributed $97 million in health care associated costs [1]. Thus, the prevention of SSI in elective surgery remains a priority.

A previous audit of records from podiatric surgeons in Australia found an infection rate of 3.1% in those who underwent a foot or ankle procedure [5]. Although this is well within acceptable ranges [6], this may be further reduced by examining factors that predict infection in this population. This information can be used in preoperative risk stratification and guide prophylactic antibiotic use, which remains a controversial topic in the foot and ankle literature [7].

Although current evidence based guidelines support a cautious approach to the use of prophylactic antibiotics in surgery, there is no evidence from Australia that specifically evaluates the use of antibiotics in the podiatry profession. Therefore, the aim of this prospective cohort study was to determine the impact of antibiotic use on infection rates following podiatric foot and ankle surgery.

Section snippets

Study population

The Australasian College of Podiatric Surgeons (ACPS) Surgical Audit Tool is the only Australian audit tool developed to assess the outcomes of foot and ankle surgery. The ACPS Surgical Audit Tool [8] used in this study was developed from a Delphi survey of an international panel of experts, experienced or associated with foot and ankle surgery. The international panel was comprised of podiatric and orthopaedic surgeons from Australia, the UK and the USA, and plastic and general surgeons from

Results

Of the 4238 patient records, 4140 records (98%) provided complete data (aged 2–92 years, mean 48.9 ± SD 19.6, 1124 males, and 3016 females). There were 79 infections (1.9% infection rate) reported. Table 1 provides a description of infection type and anatomical location.

Characteristics of participants with and without infection are shown in Table 3. There were no significant differences between participants with and without infection regarding age, sex, and ASA scores. There were however,

Discussion

The objective of this study was to determine the impact of antibiotic use on infection rates within a 30 day period following podiatric foot and ankle surgery. Although the overall infection rate was low (1.9%), we found that patients undergoing podiatric foot and ankle surgery are less likely to develop infection if they receive perioperative antibiotic prophylaxis.

Predictive factors of SSI can be divided into non-modifiable and modifiable factors. Non-modifiable factors include age [12] and

Ethics

Ethical approval was obtained from the ACPS Research Committee to access the College's de-identified audit database and was also provided by the Southern Cross University Higher Research Ethics Committee (ECN-15-337).

Authorship statement

All the authors have contributed to the design of the study and manuscript preparation. This manuscript has not been previously published and is not under consideration in any other peer reviewed media.

Conflicts of interest

The authors of this study have no conflicts of interest to declare.

Funding

None to declare.

Provenance and peer review

Not commissioned; externally peer reviewed.

Acknowledgements

The authors would like to thank those surgeons and patients who made this study possible.

References (22)

  • W.D. Owens et al.

    ASA physical status classifications: a study of consistency of ratings

    Anesthesiology

    (1978)
    • View full text
    © 2017 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.