A prospective, randomized, double-blinded, placebo-controlled clinical study on postoperative antibiotherapy in 150 arthroscopy-assisted TPLO in dogs

Vet Surg. 2018 Sep 28. [Epub ahead of print]

OBJECTIVE: To determine the influence of a 7-day course of postoperative antibiotherapy (cefpodoxime) on surgical site infections (SSI) after tibial plateau leveling osteotomy (TPLO).

STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical study.

SAMPLE POPULATION: One hundred fifty client-owned dogs, with consent.

METHODS: Dogs undergoing arthroscopy-assisted TPLO were randomly assigned to 1 of 2 groups, the placebo group receiving perioperative cefazolin and 7 days of placebo medication after surgery or the treatment group receiving perioperative cefazolin and 7 days of postoperative cefpodoxime. Twenty-seven factors were analyzed for association with SSI by using univariate analysis, Fisher's exact test, or Wilcoxon rank-sum test.

RESULTS: SSI rates did not differ (P = .34) between the placebo group (17%; 95% confidence level [CL] 7.94%-26.43%) and the treatment group (11% SSI; 95% CL 3.98%-18.88%). The probability that > 23% of dogs would benefit from postoperative antibiotherapy was less than 5%. The only association between the factors tested in this study and SSI involved the body weight (kg), with each 1 unit increase in kilogram weight increasing the odds of developing an SSI by 4.7%.

CONCLUSION: Although the wide CL may be consistent with a type II error, a 7-day course of cefpodoxime after arthroscopy-assisted TPLO did not influence postoperative SSI in the population tested here. In addition, only a small proportion of dogs would benefit from postoperative antibiotherapy under the conditions of our study.

CLINICAL SIGNIFICANCE: These results should prompt surgeons to reconsider systematic antibiotherapy after TPLO and justify additional studies to determine whether dogs predisposed to infection could benefit from such an approach.