Do you give antibiotics preoperatively to your patients with CTS?
(215 people responded to this survey question.)
Yes, routinely 33.0%, 71 responses
Under special circumstances 23.7%, 51 responses
No 39.1%, 84 responses
Other (please specify in comments) 4.2%, 9 responses
Comments:
1. Given the lack of need or efficacy in clean surgery such as CTS, I believe that to do so is close to malpractice and will only serve to worsen the already massive problem of drug-resistant bacteria
2. diabetics, re-dos
3. patients with diabetes
4. Use abx for diabetics or those with heart valves or total joint replacements.
5. Mainly for medico-legal reasons
6. Despite the literature, if you have a post-op infection, and did not give antibiotics, you lost your case!
7. We have lawyers. I think the evidence is weak for the use of antibiotics for this procedure, but early in my career I was involved in a case where a patient became infected following a trigger finger (he went swimming in the ocean 2 days post-operatively.) The "expert witness" for the plantiff stated he should have been given a 2 day course of post-operative antibiotics. an absurdity in my opinion. Lawyers well claim that the science doesn't matter because when it happens to their client, it is a 100%. Doctor who knows, maybe my client wouldn't have gotten an infection if you would have provided a pre-operative antibiotic. Thus, I am comfortable with bankrupting the American healthcare system if it prevents me from being bankrupted. That is the American way
8. Heart valve or total joint patients
9. Only in diabetics
10. Heart valves,total joints, diabetes,altered immune system
11. Redo operations in diabetics especially and women with lymphedema combined with a forearm tourniquet
12. In patients who have a total joint replacement or who receive antibiotics prior to dental procedures (heart valve replacement, heart murmur, etc.)
13. If they have heart valve disease or replacement for which the PMD or cardiologist has told them they should get Ab prophylaxis with any surgery
14. When patient has been told by other providers "antibiotics are needed for procedures", e.g. prosthetic heart valves, some total joints.
15. With heart murmurs, diabetics, rheumatiod patients and others who are immune compromised.
16. I cannot rely on the preoperative holding area to be thorough in terms of giving preoperative antibiotics to those whom I would prophylax (e.g. total joint patients), so I have a standing order. I have had one infected CTR despite this (uncontrolled DM).
17. For isolated carpal tunnel release, I only give for patients who get prophylactic antibiotics for other procedures (e.g. prosthetic heart valve).
18. In the medico-legal climate in which I practice I feel that it is not sound practice to withhold antibiotics in spite of the medical evidence that antibiotics are not necessary. Naturally, this annoys me greatly, but better to make "an error of commission than omission" in this geographic and legal locale.
19. Diabetes
20. Hospital mandates antibiotics in the "time-out" and despite fighting this, it is easier to roll over.
21. only for diabetics
22. when they have an IV (only about 50% of the time)
23. Atb's in diabetics, rheumatoid pts, over 80 physiologically, presence of a total joint replacement, any other confounding disease that would compromise immune status
24. absolutely no indication
25. If pre-op nurse hounds me enough
26. if they are local ctr then no abx. if they have iv then i give abx to keep hospital protocols happy
27. This is part of Depart and Hospital protocol
28. Immunocompromised patients
29. Only if diabetic.
30. Total joint patients and diabetics
31. I give every surgery pre-op antibiotics. If I didn't and someone got infected, I would be sued and probably lose.