title: What are the patterns of prophylactic postoperative oral antibiotic use after foot and ankle surgery?
abstract: BACKGROUND
  The CDC estimates 23% of healthcare-associated infections to be surgical site infections, with alarming prevalence of antibiotic-resistant organisms. While there is consensus regarding preoperative prophylaxis, orthopaedic surgeons' use of prophylactic postoperative oral antibiotics is less defined.
  
  
  OBJECTIVE
  We investigated surgeons' use of prophylactic postoperative oral antibiotics after elective outpatient foot or ankle procedures, identifying (1) frequency of use, (2) regimen preferences, (3) personal indications, and (4) associated experience and demographics.
  
  
  METHODS
  Using a cross-sectional survey design, a questionnaire was emailed to all active and candidate members of the American Orthopaedic Foot and Ankle Society. Supplementary questions captured demographic information. We invited 1136 members to participate; 22 addresses produced delivery failure messages, leaving 1114 members as potential participants. After nonresponses and exclusions, 312 (28%) responses were analyzed. Statistical analysis used Pearson's chi-square test, Fisher's exact test, and multivariate regression.
  
  
  RESULTS
  The majority (75%) of respondents reported use of prophylactic postoperative oral antibiotics. Most users (69%) prescribed to fewer than 25% of patients, although 16% prescribed for all elective cases. The most frequent regimen was cephalexin 500 mg four times a day (63%) and the most common duration was 5 to 7 days (50%). Surgeons' most common indications were previous infection (71%), medical comorbidities (65%), and previous wound-healing difficulties (56%). Those who do and do not prescribe prophylactic postoperative oral antibiotics showed no difference in surgical site infection rate or any demographic category.
  
  
  CONCLUSIONS
  Surgeons' reported use of prophylactic postoperative oral antibiotics after elective foot or ankle surgery was common, without demographic association. Commonalities were identified in antibiotic regimen and personal indications for this practice. Comparative clinical studies are warranted to elucidate the efficacy of prophylactic postoperative oral antibiotics and establish evidence-based guidelines for their use.
authors.affiliation: Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Michigan Health Systems, 2098 South Main Street, Ann Arbor, MI, 48103, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ruta
authors.forename: Anish R
authors.initials: AR
authors.lastname: Kadakia
authors.forename: Todd A
authors.initials: TA
authors.lastname: Irwin
mesh_terms: D000284:Administration, Oral; D000556:Ambulatory Surgical Procedures; D000842:Ankle / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D017723:Drug Utilization Review; D017558:Elective Surgical Procedures; D005528:Foot / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011182:Postoperative Care; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents