Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery?

Abstract

BackgroundThe prevalence of postoperative wound infection in patients with neuromuscular scoliosis surgery is significantly higher than that in patients with other spinal surgery. Hyperbaric oxygen has been used as a supplement to treat postsurgical infections. Our aim was to determine beneficiary effects of hyperbaric oxygen treatment in terms of prevention of postoperative deep infection in this specific group of patients in a retrospective study.MethodsForty two neuromuscular scoliosis cases, operated between 2006–2011 were retrospectively reviewed. Patients who had presence of scoliosis and/or kyphosis in addition to cerebral palsy or myelomeningocele, postoperative follow-up >1 year and posterior only surgery were the subjects of this study. Eighteen patients formed the Hyperbaric oxygen prophylaxis (P-HBO) group and 24, the control group. The P-HBO group received 30 sessions of HBO and standard antibiotic prophylaxis postoperative, and the control group (received standard antibiotic prophylaxis).ResultsIn the P-HBO group of 18 patients, the etiology was cerebral palsy in 13 and myelomeningocele in 5 cases with a mean age of 16.7 (11–27 yrs). The average follow-up was 20.4 months (12–36mo). The etiology of patients in the control group was cerebral palsy in 17, and myelomeningocele in 7 cases. The average age was 15.3 years (8–32 yrs). The average follow-up was 38.7 months (18–66mo). The overall incidence of infection in the whole study group was 11.9% (5/42). The infection rate in the P-HBO and the control group were 5.5% (1/18), and 16.6% (4/24) respectively. The use of HBO was found to significantly decrease the incidence of postoperative infections in neuromuscular scoliosis patients.ConclusionIn this study we found that hyperbaric oxygen has a possibility to reduce the rate of post-surgical deep infections in complex spine deformity in high risk neuromuscular patients.

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

“…24 , though stated as a RCT, is a cohort study by described methodology and thus assessed as such. Of the cohort studies, 26 (81.2%) were retrospective 9,[13][14][15]17,20,22,23,[25][26][27][29][30][31][33][34][35][36][37][38]40,41,44,46,47,49 , 3 (9.4%) were prospective 16,21,24 , and 3 (9.4%) was ambispective 12,43,48 in study design. The number of patients in included RCTs ranged from 30 to 326 (Median: 155), whilst that in cohort studies ranged from 42 to 10,225 (Median: 265.5).…”

“…Two studies were identified from the literature. One study investigated hyperbaric oxygen 20 , and one study investigated postoperative administration of prostaglandin E1 (PGE1) 12 . The study by Inanmaz et.…”

“…al. 20 investigated the use of hyperbaric oxygen (2.4 atmospheres for 90 min per day for 30 sessions over 6 weeks) versus standard postoperative ward management and its impact on SSI. This is a retrospective cohort study looking at a very specific subset of spinal patients i.e.…”

“…Low quality evidence on an outcome level and meta-analysis of all four studies (N=5570) demonstrates no difference in rate of SSI when ERAS clinical pathways are instituted. Subgroup meta-analysis of two studies 36,37 (N=5230) on adult patients and two studies 35,38 Two separate studies 12,20 investigated the use of hyperbaric oxygen therapy and PGE1 for SSI reduction. PGE1 is a potent vasodilator that has been previously found to reduce SSI in laryngeal surgery post irradiation 52 .…”

“…1st Protocol: 14.9 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 2nd Protocol: 13.5 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Pre-protocol 15.0 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Gender: N.R.…”