Comparison of Lavage Techniques for Preventing Incision Infection Following Posterior Lumbar Interbody Fusion

Abstract

BackgroundThe main purpose of this study was to compare the effects of various lavage techniques – traditional saline lavage (SL), pulse lavage (PL), closed drainage (CD), and iodine lavage (IL) – on preventing incision-related infection after posterior lumbar interbody fusion.Material/MethodsPatients with prolapsed lumbar (intervertebral) discs (PLID) undergoing posterior lumbar interbody fusion surgery (PLIF) over the course of 2 years were included and were randomly allocated into 4 groups: the SL group, the PL group, the CD group, and the IL group. Relevant data were recorded, including preoperative conditions, intraoperative lavage time, lavage fluid volume, incision outlook, pain perception, results of routine blood tests, and postoperative infection rate.ResultsThe PL, CD, and IL groups showed less intraoperative lavage time, lavage volume fluid, effusion, infection rate, and muscle and lower pain perception compared with the SL group (all P<0.05). Significant differences in white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were observed between preoperative and postoperative data in each group (P<0.01). No significant differences in clinical characteristics, postoperative temperature, suture removal time, incision characteristics, WBC, ESR, and CRP were observed among the PL, CD, IL, and SL groups (P>0.05).ConclusionsPL, CD, and IL all showed much better postoperative infection prevention in comparison to SL.

The Cost-Effectiveness of Normal-Saline Pulsed Lavage for Infection Prophylaxis in Total Joint Arthroplasty

“…In a prospective randomized trial on hip hemiarthroplasty for femoral neck fractures, a 2-liter PSL had a total infection rate of 5.5% compared to 15.6% for a 2-liter normal-saline gravity or bulb syringe lavage ( P = .002) [ 15 ]. Additionally, in 2 studies on spinal fusion surgeries, the infection rate of PSL vs bulb syringe lavage was 1.6% compared to 10.1% ( P = .046) and 2.5% compared to 20% ( P < .001) [ 13 , 14 ]. While efficacy data on the true ARR of PSL are sparse, what is available in the literature suggests that PSL is at least noninferior if not superior to historical lavage methods.…”

“…One method for PJI prophylaxis that has been widely adopted is the pulsed lavage of 0.9% saline (PSL) [ 12 ]. Compared to the historical use of bulb syringe or gravity lavage, PSL has shown considerable efficacy in reducing surgical site infection rates across multiple surgical subspecialties [ [13] , [14] , [15] , [16] , [17] , [18] , [19] ]. While the volume used in PSL varies depending on the anatomy of interest and surgeon preference, a few studies suggest 4 liters is optimal for TKA [ 20 , 21 ], but none have specific volume recommendations for PJI.…”

Retrospective Study from a Single Center on the Efficacy of Pulsed Lavage Following Excision of Burns ≥30% of the Total Body Surface Area in 63 Patients

“…To facilitate the flushing, patients were placed on the operating table in the best position, a sterile basin was kept below the wounds, and the table was covered with waterproof sheeting. The total volume of irrigating solution (0.9% physiological saline) depended on the situation of the wounds [ 23 ]. The volume generally was not less than 6000 mL for patients with severe burns.…”

“…Bath et al also found pulsed irrigation was more effective than bulb syringe irrigation in the posterior muscle layer [ 22 ]. Fei et al confirmed that a pulsed lavage group, closed drainage group, and iodine lavage group all showed much better postoperative infection prevention than the saline lavage group [ 23 ].…”

Efficacy and safety of Chinese herbal medicine Wuwei Xiaodu Drink for wound infection: A protocol for systematic review and meta-analysis

“…[4] Studies have shown that the incisional infection rate among trauma surgery patients was 13.64%, with the percentage of Gram-positive and Gram-negative bacteria and fungi being 47.37%, 39.47%, and 13.16%, respectively. [5][6][7] Wound infections trigger the body's immune response, causing inflammation and tissue damage, while slowing the healing process. Many minor wound infections can heal spontaneously, such as localized infections after minor skin abrasions.…”