The Use of Postoperative Antibiotics in Shoulder Arthroscopy Patients

Shoulder arthroscopy is one of the most commonly performed orthopedic surgeries, with rotator cuff repairs alone accounting for 250,000 to 275,000 cases per year in the USA.1'2 The procedure's frequency will likely continue to increase as the active aging population increases.3 There has been a parallel rise in uncommon complications like deep tissue infections due to pathogens like C. acnes f which are generally susceptible to penicillin and first-generation cephalosporins.5 Postoperative infections often gravely impact patient morbidity and mortality.6 In response, a majority of orthopedic surgeons have implemented infection reduction measures, such as the use of intraoperative pre-incision antibiotic prophylaxis with intravenous first-generation cephalosporin or clindamycin7 and benzoyl peroxide wash.8 Although the American Academy of Orthopedic Surgeons (AAOS) has not currently published guidelines specific to perioperative antibiotics in shoulder arthroscopy, practice patterns among arthroscopic surgeons strongly favor the use of intraoperative pre-incision antibiotics and generally avoid the use of postoperative antibiotics.9 While there is consensus in practice, the absence of robust guidelines for postoperative antibiotic prophylaxis after shoulder arthroscopy warrants further research. A priori power analysis was performed by modeling a two-sided Pearson chi-squared test for proportion difference with alpha level of 0.05 and statistical power of 0.80. A priori power analysis yielded a sample size requirement of 99 patients per group, which the study exceeded, confirming that the study was highly powered. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy.14 Additional risk factors for infection include patient factors (e.g., chronic disease and immunosuppression), perioperative factors (e.g., long preoperative hospitalization, early shaving of site, etc.), and intraoperative factors (e.g., foreign material and lengthy operation).15 While postoperative prophylactic antibiotic use is established and effective in several orthopedic subspecialties (arthroplasty, spine surgery, and orthopedic trauma),16 the effectiveness in arthroscopic surgery remains unclear.