Preoperative Antibiotic Administration Before Distal Radius Fracture ORIF and Postoperative Outcomes: A Propensity-Matched Cohort Study

Purpose Surgical site infections following certain hand surgery procedures are inherently low; however, the utility of prophylactic antibiotics in such scenarios remains a point of controversy. This study aimed to evaluate postoperative infection rates among patients who were prescribed antibiotics before surgery compared with those who were not following distal radius fracture (DRFx) repair surgery, using a large multi-institutional database. The study hypothesis was that the administration of preoperative antibiotics would not impact the rate of postoperative infection. Methods A retrospective matched cohort study was performed using the TriNetX Research Network, a large multicenter de-identified patient database. Adult patients undergoing DRFx repair were identified using procedural codes. Patients who received preoperative antibiotics were propensity score matched to those who did not, controlling for demographics and clinical variables. Outcomes analyzed included documentation of a postoperative infection, administration of oral antibiotics, and reoperation within 1 and 3 months after surgery. Results Among DRFx patients, postoperative infection within 1 month occurred significantly more frequently in those receiving antibiotics compared with those who did not (0.9% vs 0.2%; risk ratio [RR] = 5.7, P = .001), but no difference at 3 months. Administration of oral antibiotics within 3 months was significantly higher among those who received antibiotics prior to DRFx repair (13.7% vs 3.4%; RR=4.0, P < .001). Reoperation rates within 3 months of DRFx repair were significantly higher among those who received antibiotics as well (1.4% vs 0.9%; RR=1.6, P = .004). Conclusions In this matched cohort analysis, patients who received preoperative intravenous antibiotics had higher observed rates of 30-day postoperative infection, subsequent oral antibiotic use, and reoperation compared with those who did not. These differences most likely reflect baseline risk differences between groups rather than a true effect of antibiotic administration. Overall postoperative infection rates were low in both cohorts, and a causal conclusion regarding the efficacy of routine antibiotic prophylaxis in this setting cannot be drawn. Type of study/level of evidence III