Infection prevention strategies in shoulder surgery: A survey of fellowship-trained shoulder surgeons.

Abstract

Infection is a major complication with modifiable risk factors. We aimed to report current infection control strategies used by fellowship-trained shoulder surgeons. Members of the Shoulder and Elbow Society of Australia were invited to participate in an anonymous electronic REDCap survey. Data is presented as median(IQR) or n(%). Seventy surgeons with 18 (9-25) years of post-fellowship experience, who performed 250 (150-400) shoulder operations, and 50 (21-79) shoulder replacements annually responded. <i>Staphylococcus aureus</i> screening was performed by 11% pre-arthroscopy versus 44% pre-arthroplasty (26% and 50% gave decolonization regimens respectively). 21% prescribed anti-<i>Cutibacterium acnes</i> regimens pre-arthroscopy, versus 31% pre-arthroplasty. For prophylaxis, 89% used cefazolin and 10% used clindamycin pre-arthroscopy, versus 84% who used cefazolin and 60% vancomycin pre-arthroplasty; 43% did not routinely co-administer cefazolin when prescribing vancomycin. 99% administered antibiotics within one-hour of knife-to-skin. During arthroplasty: 40% enforced personnel limits, 31% enforced entry/exit rules, 50% used topical antibiotics, 27% used liquid-based disinfectants, and 95% changed gloves when handling implants. If cementing, 82% always used antibiotic-loaded cement. Postoperative antibiotics were given by 43% post-arthroscopy and 90% post-arthroplasty (96% and 95% gave first-generation cephalosporins respectively). There is no consensus on infection prevention in shoulder surgery. Most surgeons are compliant with evidence-based guidelines, where they exist. The data we present are not suggestions of treatment, but rather the contemporary opinion of surgeons discussed in the context of the literature as it stands.