Introduction Pyogenic flexor
tenosynovitis (PFT) is a common hand
infection that can cause significant morbidity. Although treatment involves surgical
debridement and inpatient intravenous (IV)
antibiotics, there is a paucity of literature guiding
antibiotic use. This study aims to determine if the use of postoperative outpatient oral
antibiotics leads to poor outcomes compared to IV
antibiotics given in an institutional setting. Methods A retrospective review of 110 patients treated post-operatively with either outpatient oral or inpatient IV
antibiotics at our institution from 2016-2019 was performed. All patients underwent surgical
debridement. Primary outcomes analyzed included readmission, repeat surgery, and
amputation. Clinical parameters including age, diabetes, smoking, duration of symptoms, involvement of surrounding structures (felon, dorsal
abscess,
osteomyelitis,
septic arthritis), culture growth, Michon classification, and duration of
antibiotics were analyzed as possible risk factors for poor outcome. The level of evidence of this study is Level 3 Retrospective Cohort Study. Results Seventy-five patients were treated with outpatient oral
antibiotics and 35 patients were treated with inpatient IV
antibiotics. The oral
antibiotics group received
antibiotics for 13.1 +/- 9.9 days compared to 18.1 +/-10.4 days in the IV
antibiotic group. Patients in the oral
antibiotic group had a significantly shorter length of hospitalization at 0.6 +/-1.8 days compared to 3.6 +/-1.8 days in the IV
antibiotic group. The readmission rate for the oral
antibiotic group was 10.7% compared to 5.7% in the IV
antibiotic group. This difference was not statistically significant except in patients who had involvement in surrounding structures. There was no significant difference in repeat surgeries or amputations between the groups. Conclusions The use of outpatient oral
antibiotics after surgical
debridement for PFT does not significantly increase rates of readmission, repeat surgery, or
amputation, except in cases with the involvement of surrounding structures. On subgroup analysis, anaerobic
infection and diabetes were significantly associated with
amputations. Post-operative oral
antibiotics and immediate discharge may be considered for PFT after adequate surgical
debridement with close outpatient follow-up in the absence of surrounding structure involvement and diabetes.