An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery

Shaffer, William O.; Baisden, Jamie; Fernand, Robert; Matz, Paul G.

doi:10.1016/j.spinee.2013.06.030

Cited by 111 publications

(104 citation statements)

References 24 publications

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“…We found substantial differences between IWA and non-IWA patients that would suggest differential use, but the patients receiving IWA were surprisingly more likely to have attributes that placed them at lower risk for SSI, such as greater rates of private insurance, lower rates of smoking, and lower rates of prior surgery. This is contrary to the recommendations from the North American Spine Society [19] and may reflect surgeon or site preference, rather than patient risk stratification. These risk factors need to be accounted for when comparing the rates of SSI, and e Based on number of instrumentation levels, decompressive levels and fusion levels.…”

Section: Discussioncontrasting

confidence: 73%

“…Surgical site infection can occur as late as 12 mo or more after skeletal surgery with implants [16][17] and biofilms that form on implants may contribute to SSI in ways that have not been well assessed [18]. Despite these gaps and the uncertain evidence, clinical guidelines from the North American Spine Society include a recommendation to add IWA ''in patients with comorbidities or for those undergoing complicated spine surgery'' [19].…”

mentioning

confidence: 99%

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Intra-Wound Antibiotics and Infection in Spine Fusion Surgery: A Report from Washington State's SCOAP-CERTAIN Collaborative

Ehlers

Khor

Shonnard

et al. 2016

Surgical Infections

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Background: Surgical site infection (SSI) after spine surgery is classified as a ''never event'' by the Centers for Medicare and Medicaid. Intra-wound antibiotics (IWA) have been proposed to reduce the incidence of SSI, but robust evidence to support its use is lacking. Methods: Prospective cohort undergoing spine fusion at 20 Washington State hospitals ( July 2011 to March 2014) participating in the Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP) linked to a discharge tracking system. Patient, hospital, and operative factors associated with SSI and IWA use during index hospitalizations through 600 days were analyzed using a random effects logistic model (index), and a time-to-event analysis (follow-up) using Cox proportional hazards. Results: A total of 9,823 patients underwent cervical (47%) or lumbar (53%) procedures (mean age, 58; 54% female) with an SSI rate of 1.1% during index hospitalization. Those with SSI were older, more often had diabetes mellitus, and more frequently underwent lumbar (versus cervical) fusion compared with those without SSI (all p < 0.01). Unadjusted rates of SSI during index hospitalization were lower in patients who received IWA (0.8% versus 1.5%). After adjustment for patient, hospital, and operative factors, no benefit was observed in those receiving IWA (odds ratio [OR] 0.65, 95% confidence interval [CI]: 0.42-1.03). At 12 mo, unadjusted rates of SSI were 2.4% and 3.0% for those who did and did not receive antibiotics; after adjustment there was no significant difference (hazard ratio [HR] 0.94, 95% CI: 0.62-1.42). Conclusions: Whereas unadjusted analyses indicate a nearly 50% reduction in index SSI using IWA, we did not observe a statistically significant difference after adjustment. Despite its size, this study is underpowered to detect small but potentially relevant improvements in rates of SSI. It remains to be determined if IWA should be promoted as a quality improvement intervention. Concerns related to bias in the use of IWA suggest the benefit of a randomized trial.

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Section: Discussioncontrasting

confidence: 73%

mentioning

confidence: 99%

Intra-Wound Antibiotics and Infection in Spine Fusion Surgery: A Report from Washington State's SCOAP-CERTAIN Collaborative

Ehlers

Khor

Shonnard

et al. 2016

Surgical Infections

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“…34,35 Further, several patient associated risk factors have been identified for SSI including diabetes and obesity. Other risk factors such as smoking are debatable.…”

Section: Discussionmentioning

confidence: 99%

Do Preoperative Corticosteroid Injections Increase the Risk for Infections or Wound Healing Problems After Spine Surgery?

Farshad

Burgstaller

Held

et al. 2018

Spine

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“…Pharmacokinetic studies with intravenous vancomycin have demonstrated difficulties in delivering targeted concentrations even when a continuous intravenous infusion was used after the loading dose (38,46). Increasing the loading dosage of vancomycin runs the risks of adverse events such as hypotension, flushing, rashes, colitis, and Stevens-Johnson Syndrome (45).…”

Section: Parenteral Vancomycin Administrationmentioning

confidence: 99%

The Use of Vancomycin Powder In Modern Spine Surgery: Systematic Review and Meta-Analysis of the Clinical Evidence

et al. 2015

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An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery

Cited by 111 publications

References 24 publications

Intra-Wound Antibiotics and Infection in Spine Fusion Surgery: A Report from Washington State's SCOAP-CERTAIN Collaborative

Intra-Wound Antibiotics and Infection in Spine Fusion Surgery: A Report from Washington State's SCOAP-CERTAIN Collaborative

Do Preoperative Corticosteroid Injections Increase the Risk for Infections or Wound Healing Problems After Spine Surgery?

The Use of Vancomycin Powder In Modern Spine Surgery: Systematic Review and Meta-Analysis of the Clinical Evidence

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