PROPHYLACTIC PERIOPERATIVE ANTIBIOTICS

Four low quality studies demonstrate limited evidence suggesting that perioperative prophylactic antibiotics are not indicated for the prevention of surgical site infection following carpal tunnel release. Multiple retrospective reviews have demonstrated that the use of prophylactic antibiotics for carpal tunnel release does not decrease the rate of infection, even in patients with diabetes (Harness 2010, Mehta 2022, Tosti 2012, Vasconcelos 2017). A claims database study evaluating the effectiveness of perioperative antibiotics for common soft tissue hand procedures that controlled for several patient demographic factors through propensity score matching demonstrated no difference in infection rates between cohorts with and without perioperative prophylactic antibiotics (Li, 2018). Notably, this study, despite including over 60,000 patients undergoing carpal tunnel release (>50% of included patients) was not included in the evidence as the infection rate was not detailed by condition.

Benefits/Harms of Implementation
The benefit of perioperative prophylactic antibiotics is the prevention of surgical site infection; however, this has not been demonstrated in the literature. The harm of perioperative prophylactic antibiotics includes risks related to the side effects of antibiotics (allergic reactions, development of drug-resistant organisms, and Clostridium difficile infection) without the proven benefit of reducing infections.

Cost Effectiveness/Resource Utilization
There are costs associated and resources utilized in the delivery of perioperative antibiotics and the treatment of downstream adverse effects.

Acceptability
It is accepted practice to limit the overuse of antibiotics although not strictly practiced by all surgeons due to other guidelines for major surgery that support the routine administration of preoperative antibiotics (e.g., total joint arthroplasty).

Feasibility
There are no feasibility issues with the implementation of this recommendation as it suggests limited unnecessary care.

Future Research
Future research should address the strength of recommendation through more condition-specific analyses for the use of preoperative antibiotics.