Troy Morrison, DO; Braeden Arnold, OMS IV
Citizens Memorial Hospital, Bolivar, MO; Kansas City University of Medicine and Biosciences, Kansas City, MO
Background
Both oral and topical doxycycline have been shown to have positive therapeutic effects when used in wounds; however, no studies have assessed adverse events, healing and anti-inflammatory effects, and workability of intrawound doxycycline when used in total joint replacement and spine surgery.
Methods
This retrospective cohort study assessed two groups of patients that underwent total joint replacement or spine surgery: those who received intrawound doxycycline powder and those who did not. Outcomes were analyzed between the group that received intrawound doxycycline and the group without intrawound doxycycline using the two-sample t-test for continuous variables and the chi-square test with Fischer’s P value for categorical variables.
Results
The study included 75 patients in the no-intrawound doxycycline group and 60 in the intrawound doxycycline group. Baseline characteristics between each group were non-significant (table 1). There were no significant differences post-operatively when assessing post-operative WBC, post-operative day 1 erythema, post-operative day 1 swelling, incisional blistering, wound dehiscence, wound healing at 2 weeks, emergency room visits, readmissions, and reoperations (table 2). The post-operative albumin was significantly lower in the doxycycline cohort.
Discussion
Our study found minimal differences in outcomes between patients without intrawound antibiotic and intrawound doxycycline patients that underwent orthopedic surgical procedures. The study did not find a significant difference between the healing rate of the control cohort and the intrawound doxycycline cohort; however, we recognize that more studies are needed to evaluate the use of doxycycline due to the limited number of studies published. We hypothesize the significant decrease between the pre- and post-operative albumin levels is an incidental finding as hepatotoxicity caused by doxycycline is a rare occurrence and no patient during the present study presented with signs or symptoms of liver abnormalities. Finally, we concluded that of the emergency room visits, readmissions, and reoperations reviewed, a large proportion a result of a fall, are likely due to natural issues that arise with older age as doxycycline to our knowledge is not associated with an increase in falls.
