A prospective, randomized, double‐blinded, placebo‐controlled clinical study on postoperative antibiotherapy in 150 arthroscopy‐assisted tibial plateau leveling osteotomies in dogs

Objective To determine the influence of a 7‐day course of postoperative antibiotherapy (cefpodoxime) on surgical site infections (SSI) after tibial plateau leveling osteotomy (TPLO). Study design Prospective, randomized, double‐blinded, placebo‐controlled clinical study. Sample population One hundred fifty client‐owned dogs, with consent. Methods Dogs undergoing arthroscopy‐assisted TPLO were randomly assigned to 1 of 2 groups, the placebo group receiving perioperative cefazolin and 7 days of placebo medication after surgery or the treatment group receiving perioperative cefazolin and 7 days of postoperative cefpodoxime. Twenty‐seven factors were analyzed for association with SSI by using univariate analysis, Fisher's exact test, or Wilcoxon rank‐sum test. Results SSI rates did not differ (P = .34) between the placebo group (17%; 95% confidence level [CL] 7.94%‐26.43%) and the treatment group (11% SSI; 95% CL 3.98%‐18.88%). The probability that > 23% of dogs would benefit from postoperative antibiotherapy was less than 5%. The only association between the factors tested in this study and SSI involved the body weight (kg), with each 1 unit increase in kilogram weight increasing the odds of developing an SSI by 4.7%. Conclusion Although the wide CL may be consistent with a type II error, a 7‐day course of cefpodoxime after arthroscopy‐assisted TPLO did not influence postoperative SSI in the population tested here. In addition, only a small proportion of dogs would benefit from postoperative antibiotherapy under the conditions of our study. Clinical significance These results should prompt surgeons to reconsider systematic antibiotherapy after TPLO and justify additional studies to determine whether dogs predisposed to infection could benefit from such an approach.