Effectiveness of Perioperative Antibiotic Prophylaxis in Total Ankle Arthroplasty: A Multicenter Retrospective Analysis of Infection Rates and Patient Characteristics

Submission Type: Total Ankle Arthroplasty Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Periprosthetic joint infections following total ankle arthroplasty occur at an estimated rate of 2% to 8.6%, while surgical site infections in foot and ankle surgery range from 2% to 4.5%. Despite these risks, there is limited evidence supporting the routine use of antibiotic prophylaxis in total ankle arthroplasty. This study aimed to assess the characteristics of patients receiving perioperative antibiotics compared to those who do not. Rates of periprosthetic, superficial and deep surgical site infection were compared between the two cohorts. Methods: This retrospective study utilized a multicenter network of deidentified data abstracted from electronic medical records (TriNetX). ICD-10 and CPT codes were used to identify patients from 50 health care organizations who underwent total ankle arthroplasty. Patients were then divided into two cohorts: those who received perioperative antibiotic administration and those that did not receive any perioperative antibiotics. These cohorts were compared to identify differences in demographics and co-morbidities between the two groups. The two cohorts were then propensity score matched and the rate of postoperative infection within 1 year was compared between groups. Results: This query identified 5,449 patients who received perioperative antibiotic prophylaxis and 1,019 patients who did not receive antibiotics. Average age at time of surgery in the antibiotic cohort was significantly higher than the non-antibiotic cohort (61.7 ± 12.4 years vs 54.3 ± 17.5 years, p< 0.01). The antibiotic group also had significantly higher rates of obesity (22% vs 17%, p< 0.01) as well as cardiovascular and respiratory diseases including hypertension (42% vs 32%, p< 0.01), ischemic heart disease (10% vs 7%, p=0.02), asthma (10% vs 7%, p< 0.01), and chronic obstructive pulmonary disease (4% vs 2%, p=0.02). The risk of any postoperative infection within 1 year of surgery was not significantly different between groups (4.4% vs 2.9%, p=0.13). Conclusion: This study reveals that patients who receive perioperative antibiotics for total ankle arthroplasty are typically older age and are more likely to have a history of obesity, cardiovascular and respiratory disease. However, when controlling for these co-morbidities, infection rates were equivalent between patients who did and did not receive perioperative antibiotics. These findings suggest that certain patient demographics are more likely to receive perioperative antibiotics following a total ankle arthroplasty but the rate of post-surgical infection is not affected.