I am having a carpal tunnel release surgery next week. The surgeon has suggested putting me on some antibiotics to help prevent skin infections because I have diabetes. I'm really against using antibiotics for every little thing but maybe this is one time I should give in. What do you think?
People with diabetes do have a tendency to develop problems with the incision site after surgery. They are four times more likely to have a failure of the wound to close properly. The suture line (where the stitches hold the skin together) is more likely to develop thickening tissue called suture granulomas. Removing the sutures without tearing the skin can become a real problem. Diabetes is also a known risk factor for skin infections. So is smoking. Experts think that the delay in wound closure caused by the effects of diabetes is the real problem. Until the wound is closed, the area is susceptible to bacteria entering and causing infection. A recent study from the Department of Plastic and Reconstructive Surgery at Johns Hopkins University in Baltimore, Maryland may offer you some helpful information. The researchers looked at the medical records of 8,850 patients who had hand surgery between the year 2000 and 2008. They compared the outcomes of two groups of patients. The first group received prophylactic (preventive) antibiotics. Of the 8,850 patients, one-third were in this group. The second group (the remaining two-thirds) had the same type of surgery but they did not receive prophylactic antibiotics. Patients were followed closely after surgery to determine whether or not a superficial skin infection (SSI) developed. In all 8,850 patients, there was an overall superficial skin infection (SSI) rate of 0.35 per cent. That's a very low rate of SSI. And the rate wasn't different between the two groups. That suggests the use of prophylactic antibiotics for routine hand surgery isn't really needed. Late infections (those that develop a month or more after surgery) were not a part of this study. This type of infection is related more to poor wound care. But just to be sure, the authors did a subanalysis to see if patients with certain risk factors for infection were less likely to develop an infection if they did get the "just-in-case" (prophylactic) antibiotic. An analysis of data collected on the patients showed three risk factors linked with developing a skin infection. These three things included diabetes, procedure length (the longer time in surgery, the greater the risk of infection), and tobacco use (cigarette smokers were at increased risk). But the big news is that patients with these risk factors do NOT reduce their risk of a skin infection by taking a preventive antibiotic. The natural conclusion is that prophylactic antibiotics are not needed by anyone when having simple, elective hand surgery. This guideline extends to include even those who have a known increase in risk of infection following surgery (including diabetes). The rate of postoperative skin infection is very low already. Taking an antibiotic does not lower that rate at all. More study is needed in this area before surgeons will be able to say antibiotics are never helpful before elective surgery like carpal tunnel surgery. Your surgeon may have some specific reasons why he or she thinks you would benefit from this course of action.