What do pimply, embarrassed teenagers have in common with those undergoing shoulder surgery? They can both benefit from the active ingredient in Clearasil, says a new paper to be published in The Journal of Shoulder and Elbow Surgery. Researchers from Yale University have found that topical benzoyl peroxide (BPO), with chlorhexidine skin preparation can reduce P. acnes on patients’ skin and perhaps lower the risk of postoperative infection.
Clearasil for Shoulder Surgery?
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“The setbacks and costs associated with infection after shoulder surgery are significant, ” said senior author Paul M. Sethi, M.D., Clinical Instructor of Orthopedic Surgery Yale University School of Medicine, in the June 30, 2015 news release. “Our first study identified the patients’ skin as the source of bacteria that may cause infection and highlighted the limitations of current skin surgical preparation. Our team used established dermatologic principles to improve the way we clean the skin. Dermatologists have used BPO to treat P. acnes on our face for 50 years. We chose to study this same medicine on the shoulder and the findings are very exciting. Data demonstrates that we can significantly reduce potentially dangerous bacteria after skin treatment with BPO. By reducing these bacteria, we hope to reduce the risk for shoulder infection following surgery.”
Dr. Sethi told OTW, “P. acnes is one of the most significant pathogens in shoulder surgery; the cost of a single infection after shoulder arthroplasty may be upwards of $50, 000. We have been working to define evidence based methods to reduce the risk of infection to improve the outcome and value of shoulder surgery.”
“Based on our predicate study, we found that current skin preparations leave residual bacteria on the skin 15% of the time at the beginning of a surgical procedure, and up to 66% of the time by the end of surgery in men. These high rates of residual bacteria, which may be one of the causes of post operative infection, encouraged us to identify enhanced methods of surgical skin preparation.”
As for future research, Dr. Sethi noted, “We plan on a multi-center longitudinal study to determine if this new skin preparation will reduce the actual rate of infection in shoulder arthroplasty across a broad group of patients. This is very exciting as this is a simple, safe and inexpensive way to reduce post operative infection, a potentially devastating problem.”
This research comes out of the ONS Foundation for Research in Education (ONSF).
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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