How can you prevent infection after shoulder surgery?

Does what you do before surgery affect your outcome? Most would think that our actions after surgery would have more impact. There are several factors that can contribute to your risk for infection following surgery.

Infection after shoulder surgery is uncommon, but when it occurs, the impact on the outcome can be substantial. For shoulder arthroscopy the risk is less than 1 in 1000. For shoulder replacements (arthroplasty) the risk is 1-2% in the published papers. We take several steps to prevent infection and my rate of infection after shoulder replacement is less than 1%.

Shorter surgical time

A shorter surgical time is associated with a lower rate of infection. Other factors include surgical technique, irrigation, and use of antibiotics (IV prior to surgery and topical antibiotics in the wound). One preoperative step discussed here can be used by the patient regardless of the surgeon.

Prep before surgery

The most common cause of shoulder infection is C. acnes (formerly called P. acnes). C. acnes lives in the sebaceous glands around the shoulder. These are deep to the skin, so C. acnes is not commonly eliminated by simple skin preps just prior to surgery. C. acnes is sensitive to benzoyl peroxide, which is an over-the-counter antibiotic that can be applied to the skin several days prior to surgery. Two recent articles have shown that this can be effective.

1. In the first study, published from the University of Maryland, two groups were compared. In the first, patients washed the shoulder with chlorhexidine for 3 days prior to surgery. This is a common practice, especially for lower extremity procedures. In the second group, patients washed the shoulder with 5% benzoyl peroxide for 3 days prior to surgery. In the first group there was no change in the presence of C. acnes. In the second group, however, C. acnes was reduced by 10 times.
2. In the second study, performed in Sweden, patients used 5% benzoyl peroxide for 2 days prior to surgery. Only 1 of 20 patients who used the benzoyl peroxide were found to have C. acnes on the skin at the time of surgery, compared to 7 of 20 who used a standard prep. A dramatic difference.

What I advise

In my practice, I advise all patients who are having shoulder surgery to wash the shoulder with 5 to 10% benzoyl peroxide for 3 days prior to surgery. This simple step is easy to do and may help prevent infection after shoulder surgery.

Dr. Patrick Denard has been voted one of the top 20 Shoulder Surgeons in North America, and is the most widely published shoulder specialist in Oregon.