ANTIBIOTIC PROPHYLAXIS IN FOREFOOT SURGERY – EXPLORING THE MYTH

Abstract

Introduction: Hallux valgus corrective surgery is frequently performed, often with the administration of prophylactic antibiotics, although opinion is divided as to whether these antibiotics confer any benefit with little being published on the subject. The few papers that have been published suggest that there is no difference in infection rates, with the overall rate 1–2%.

Furthermore, the increasing incidence of multi-resistant bacteria is a concern to all. The Scottish Health Executive has identified the rationalisation of antibiotic prescribing as one of the principal means of reducing the development of these organisms.

Materials and Methods: All patients undergoing hallux valgus surgery via a first metatarsal osteotomy were included, excluding repeat surgery to the same foot. The operation performed, the use of prophylactic antibiotics and the incidence of postoperative infection were all prospectively recorded. Infection was defined using the Scottish Surgical Site Infection Surveillance criteria.

In addition, Orthopaedic Consultants in the west of Scotland were contacted asking whether they use antibiotics in hallux valgus surgery and what their perception of infection risk was.

Results: The study is currently ongoing. Currently, we have completed data for 64 patients (43 with prophylactic antibiotics, 21 without). Two patients developed a post operative infection both of whom had received prophylactic antibiotics.

Thirty-five consultants replied, of which 15 regularly performed surgery for hallux valgus. Prophylactic antibiotics were used by seven, with the average perception of infection risk 4%.

Discussion: The current results appear to support the literature in suggesting there is no difference in the incidence of infection between those receiving prophylactic antibiotics and those not. We aim to continue this study, aiming for over 100 patients.

Conclusion: Antibiotic prophylaxis during hallux valgus surgery does not appear to lower the risk of postoperative infection, with the overall risk of infection lower than what is generally perceived.