Prophylactic Antibiotics for Uncomplicated Upper-Extremity Lacerations: A Retrospective Cohort Study of Private Insurance Claims

Abstract

Purpose

Despite limited evidence for their effectiveness, antibiotics are frequently prescribed after uncomplicated upper-extremity lacerations. We analyzed rates of prophylactic antibiotic prescriptions and risk factors for infection after upper-extremity lacerations that were acutely repaired in emergency departments (ED).

Methods

Using the IBM MarketScan Commercial Claims and Encounters database, we conducted a retrospective cohort study of adult patients with uncomplicated upper-extremity lacerations repaired in the ED between 2010 and 2020. In addition to univariate analyses, multivariable models were used to predict the likelihood of antibiotic prescriptions and to assess their independent relationship to infections.

Results

We identified 249,261 patients with upper-extremity lacerations repaired in the ED. Of these, 147,964 lacerations (59.4%) were shorter than 2.5 cm, and 224,581 (90.1%) were coded as simple repairs. Prophylactic antibiotics were given to 49,609 (19.9%). Overall, the 30-day infection rate was 2.1%. Individuals who underwent complex repair were more likely to fill antibiotic prescriptions compared with those undergoing simple repair (40.2% vs 18.2%), but no clinically meaningful difference in subsequent infections was observed (1.9% vs 2.0%). We performed a least absolute shrinkage and selection operator regression that predicted antibiotic prescriptions with moderate discrimination (area under the curve = 0.67). A propensity-score balanced logistic regression found that antibiotics were independently associated with greater odds of infection (odds ratio = 1.31, 95% confidence interval: 1.23–1.41).

Conclusions

Infections after acute repairs of upper-extremity lacerations were rare. One in five patients received prophylactic antibiotics, a lower prescribing rate than previously reported. Receiving antibiotics was associated with an increased odds of infection after controlling for multiple demographic and clinical variables, but a causal relationship cannot be established from these data. We did not find evidence that supports routine use of prophylactic antibiotics to prevent infections in uncomplicated upper-extremity lacerations.

Type of study/level of evidence

Therapy/Prevention IIb.