Surgical Site Infection Prevention Following Spine Surgery

Abstract

Study Design: Literature review. Objectives: Surgical site infection (SSI) following spine surgery leads to significant patient morbidity, mortality, and increased health care costs. The purpose of this article is to identify risk factors and strategies to prevent SSIs following spine surgery, with particular focus on avoiding infections in posterior cervical surgery. Methods: We performed a literature review and synthesis to identify methods that can be used to prevent the development of SSI following spine surgery. Specific pearls for preventing infection in posterior cervical spine surgery are also presented. Results: SSI prevention can be divided into patient and surgeon factors. Preoperative patient factors include smoking cessation, tight glycemic control, weight loss, and nutrition optimization. Surgeon factors include screening and treatment for pathologic microorganisms, skin preparation using chlorhexidine and alcohol, antimicrobial prophylaxis, hand hygiene, meticulous surgical technique, frequent irrigation, intrawound vancomycin powder, meticulous multilayered closure, and use of closed suction drains. Conclusion: Prevention of SSI following spine surgery is multifactorial and begins with careful patient selection, preoperative optimization, and meticulous attention to numerous surgical factors. With careful attention to various patient and surgeon factors, it is possible to significantly reduce SSI rates following spine surgery.

Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery

“…In addition, the use of corticosteroids, radiotherapy, chemotherapy, and an inability to walk in the 30 days prior to surgery were not related to the increased occurrence of surgical site infection. These findings differ from those of previous studies (4,6,14,(16)(17)(18). Possible explanations for the fact that diabetes and smoking did not change the infection rate may be that patients after a diagnosis of metastatic cancer change their lifestyle or have better control of blood glucose and hematological parameters in outpatient clinics or during hospitalization.…”

The Utility of Prolonged Prophylactic Systemic Antibiotics (PPSA) for Subfascial Drains After Degenerative Spine Surgery

“…SSIs following spine surgery can result in increased healthcare costs, prolonged hospitalizations, and overall poor patient outcomes. 8,9 Placement of subfascial surgical drains may potentially increase the risk of patients developing a surgical infection. 10 This investigation sought to evaluate the utility of prolonged antibiotics while a surgical drain remains to see the impact on developing a surgical site infection in patients undergoing traditional midline spine surgery for degenerative pathology.…”

Use of antibiotic-impregnated beads in the treatment of lumbosacral surgical site infection: A retrospective case series

“…SSIs are complex scenarios and their ideal management requires a multi-pronged strategy to effectuate local as well as systemic eradication of the disease. 13,14 While systemic antibiotic therapy remains the cornerstone of treatment, effective use of modalities which enable local disease control is of paramount importance too. 1,8e12,15 Some of the adjuvant modalities, which aid in curbing the local disease, include VAC application, continuous suctionirrigation (with normal saline or antibiotic solutions) technique, local antibiotic carrier systems and nanotechnology-based strategies with antimicrobial properties.…”