Single-dose antibiotic prophylaxis for lower extremity arthroplasty in the ambulatory setting is non-inferior to multiple-dose regimens

Background: With the rise of hip and knee arthroplasties in outpatient settings, optimizing outcomes is crucial. Periprosthetic joint infection is a rare but serious complication following joint arthroplasty. There is limited evidence comparing single-dose versus multiple-dose antibiotic prophylaxis for infection prevention after joint arthroplasties in ambulatory surgery centers, where an increasing number of these surgeries are performed. Methods: We retrospectively reviewed 374 patients from an ambulatory surgery center and 313 patients from a hospital setting undergoing total hip arthroplasty, total knee arthroplasty, and partial knee arthroplasty between 2017 and 2021. The primary outcome was the rate of infection within 90 days post-surgery. Secondary outcome was the rate of infection within 1 year postoperatively. Demographic and clinical variables such as age, body mass index, and comorbidities were collected and adjusted for in multivariate analysis. Results: Ninety-day infection rates were 0.5% in the ambulatory surgery center cohort and 0.6% in the hospital cohort, with no statistically significant difference ( P =1.00). Multivariate logistic regression showed that ambulatory surgery patients had a higher but non-significant odds ratio for infection (2.04, 95% CI: 0.184-22.574) compared to patients from the hospital setting. Both groups also showed no significant differences in 1-year infection rates. Conclusion: Single-dose antibiotic prophylaxis in ambulatory surgery centers is associated with low postoperative infection rates in outpatient joint arthroplasties and is non-inferior to multiple-dose regimens used in hospital settings. These findings support the use of single-dose prophylaxis in outpatient care, aligning with the trend toward outpatient surgery and highlighting its effectiveness for infection prevention. Level of Evidence: III.