Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary

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. The authors systematically evaluate the literature, and provide evidencebased recommendations on postoperative measures for SSI prophylaxis in spine surgery. 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 formulation of recommendation. 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. Results Forty-one studies (9 RCT, 32 cohort studies) were included. In the setting of standard-of-care preincisional antimicrobial prophylaxis (AMP) administration, the use of postoperative AMP for SSI reduction is not necessary in decompression-only or lumbar spine fusion surgery. Prolonged administration of AMP for more than 48h postoperatively does not seem to reduce 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 infectionspecific protocols does not seem to reduce rate of SSI in spine surgery. There is insufficient evidence to provide recommendations on all other types of spine surgeries with respect to their respective indications and postoperative SSI prophylactic measures. This also includes other non-AMP pharmacological measures, dressing type & duration, suture & staples management and postoperative nutrition for SSI prophylaxis in spine surgery. Conclusion 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

Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation

“…Other studies have indicated that a modified Glasgow prognostic score ≧1, BMI ≦20.39 kg/m 2 [ 28 ], postoperative hyperglycemia, poor postoperative blood glucose control [ 29 ], perioperative hypoalbuminemia, and chronic steroid use are risk factors for SSI in spinal internal fixation [ 30 ]. The use of prophylactic antibiotics during the perioperative period and the correction of anemia and hypoalbuminemia are very important [ 31 , 32 ]. A strict aseptic technique should be the basis, and direct contact with the internal instrument should be avoided as much as possible ( Figure 2 ).…”

The Team Approach to Spinal Cord and Dorsal Root Ganglion Stimulation: A Guide for the Advanced Practice Provider

“…Those characteristics that place the patient at an increased risk include advanced age, poor nutritional status, poor oral hygiene, immunocompromised state, preoperative use of steroids, preoperative use of high-dose opioids, uncontrolled diabetes, obesity, history of methicillin-resistant Staphylococcus aureus colonization, and smoking. 22 , 23 , 24 , 25 The APPs should familiarize themselves with the current best practice guidelines for infection control measures for the prevention of SSI. The NACC critically appraised the literature as well as reviewed recommendations provided by the National Institute for Health Care and Excellence, the Centers for Disease Control and Prevention, and the Surgical Care Improvement Project to produce a best practice guideline for the neuromodulation arena in an effort to reduce the risk of SSI.…”

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

“…Despite great advances in antibiotics and surgical instruments over the past few decades, wound healing following PLF surgery still remains a challenging clinical problem. Many studies were conducted to discuss the risk factors and treatment for postoperative SSI [7,13], however, few literature reporting other wound problem including wound drainage and wound dehiscence which might also contribute to a reduction of satisfaction were found. In present study, the rates of wound dehiscence and persist wound drainage were 4.5% and 6.7%, which was higher than the rate of postoperative SSI.…”

“…Some studies also identi ed that the application of the ERAS program was associated with a reduction of the length of stay (LOS) and postoperative complications in patients undergoing spinal fusion surgery [11,12]. However, the relationship between ERAS and wound healing remains poorly characterized, some studies reported that ERAS did not result in reduction of SSI, which is not consistent with others, additionally, underlying mechanisms for such relationship are still unknown [13,14].…”