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Title: Prophylactic Postoperative Measures to Minimize Surgical Site Infections in Spine Surgery: Systematic Review and Evidence Summary.
Austin Authors: Tan, Terence;Lee, Hui;Huang, Milly S;Rutges, Joost;Marion, Travis E;Matthew, Joseph;Fitzgerald, Mark;Gonzalvo, Augusto ;Hunn, Martin K;Kwon, Brian K;Dvorak, Marcel F;Tee, Jin
Affiliation: National Trauma Research Institute, Melbourne, Victoria, Australia
Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
Vancouver Spine Surgery Institute, Dept. of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
ICORD (International Collaboration on Repair Discoveries), University of British Columbia, Vancouver, BC, Canada
Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
Department of Orthopaedics, Erasmus MC, Rotterdam Area, Netherlands
Department of Orthopaedic Surgery, Northern Ontario School of Medicine, Ontario, Canada
Issue Date: Mar-2020 2019-09-23
Publication information: The Spine Journal 2019; online first: 23 September
Abstract: There are three phases in prophylaxis of surgical site infections (SSI): preoperative, intraoperative and postoperative. There is lack of consensus and paucity of evidence with SSI prophylaxis in the postoperative period. To systematically evaluate the literature, and provide evidence-based summaries on postoperative measures for SSI prophylaxis in spine surgery. Systematic review, meta-analysis, evidence synthesis METHODS: A systematic review conforming to PRIMSA guidelines was performed utilizing PubMed (MEDLINE), EMBASE, and the Cochrane Database from inception to January 2019. The GRADE approach was used for quality appraisal and synthesis of evidence. Six postoperative care domains with associated key questions were identified. Included studies were extracted into evidence tables, data synthesized quantitatively and qualitatively, and evidence appraised per GRADE approach. Forty-one studies (9 RCT, 32 cohort studies) were included. In the setting of pre-incisional antimicrobial prophylaxis (AMP) administration, use of postoperative AMP for SSI reduction has not been found to reduce rate of SSI in lumbosacral spine surgery. Prolonged administration of AMP for more than 48h postoperatively does not seem to reduce the rate of SSI in decompression-only or lumbar spine fusion surgery. Utilization of wound drainage systems in lumbosacral spine and adolescent idiopathic scoliosis corrective surgery does not seem to alter the overall rate of SSI in spine surgery. Concomitant administration of AMP in the presence of a wound drain does not seem to reduce the overall rate of SSI, deep SSI, or superficial SSI in thoracolumbar fusion performed for degenerative and deformity spine pathologies, and in adolescent idiopathic scoliosis corrective surgery. Enhanced-recovery after surgery (ERAS) clinical pathways and infection-specific protocols do not seem to reduce rate of SSI in spine surgery. Insufficient evidence exists for other types of spine surgery not mentioned above, and also for non-AMP pharmacological measures, dressing type & duration, suture & staple management and postoperative nutrition for SSI prophylaxis in spine surgery. Despite the postoperative period being key in SSI prophylaxis, the literature is sparse and without consensus on optimum postoperative care for SSI prevention in spine surgery. The current best evidence is presented with its limitations. High quality studies addressing high risk cohorts such as the elderly, obese and diabetic populations, and for traumatic and oncological indications are urgently required.
DOI: 10.1016/j.spinee.2019.09.013
PubMed URL: 31557586
Type: Journal Article
Subjects: Antibiotic prophylaxis
Cervical Vertebrae
Clinical care pathway
Drain tube
Lumbar vertebrae
Spinal Fusion
Surgical site infection
Surgical wound infection
Thoracic vertebrae
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