Discontinuation of Postoperative Prophylactic Antibiotics After Noninstrumented Spinal Surgery: Results of a Quality Improvement Project

Lewis, Ariane; Lin, Jessica; James, Herbert; Hill, Travis C.; Sen, Rajeev; Pacione, Donato

doi:10.1177/1941874417748542

Cited by 6 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This difference may reflect continuing systemic antibiotics the entire duration of time for which surgical drains are in place postoperatively. 8 The greatest variation in our survey was in peripheral nerve surgery. In these procedures, many of which are also performed by orthopedic or plastic surgeons in both inpatient and outpatient settings, the role of antibiotic prophylaxis is unclear due to the low incidence of SSI.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis practices in neurosurgery: A Society for Healthcare Epidemiology of America (SHEA) survey

Sastry

Wang

Mermel

2021

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis practices in neurosurgery: A Society for Healthcare Epidemiology of America (SHEA) survey

Sastry

Wang

Mermel

2021

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

“…Individual decisions for alternative removal times were based on surgeons’ assessment. Several studies involving spinal surgery including drains found no difference in SSI proportions between SAP for the duration for which the drain was in site versus SAP for 24 h post-operative [ 29 – 31 ]. In addition, a meta-analysis and a more recent RCT found no benefit of drains in hip arthroplasty in connection with wound complications [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Implementation and adherence to guidelines is reportedly insufficient and non-adherence may even lead to higher SSI proportions [ 6 , 21 , 22 ]. Furthermore, most studies in the literature evaluate SSI and SAP in patients undergoing either prosthetic surgery of the hip or knee [ 8 , 16 , 18 , 21 , 23 – 26 ], knee arthroscopy [ 27 , 28 ] or spinal surgery [ 29 – 31 ]. To our knowledge, no study has reported SAP use and SSI proportions in a broad population undergoing elective orthopaedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Prolonged antibiotic prophylaxis use in elective orthopaedic surgery – a cross-sectional analysis

Rohrer

Maurer

Noetzli

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Purpose Surgical antibiotic prophylaxis (SAP) prevents surgical site infections (SSI). In orthopaedic surgery, the use of prolonged SAP (PSAP) has been reported in daily routine, despite guidelines advising against it. Therefore, we asked: What is the proportion of PSAP use, defined as administration of SAP ≥24 h after elective orthopaedic surgery? Are there patient- and surgery-related predictors of PSAP use? Methods This cross-sectional analysis investigated 1292 patients who underwent elective orthopaedic surgery including total joint arthroplasties at one Swiss centre between 2015 and 2017. Patient comorbidities, surgical characteristics and occurrence of SSI at 90 days in PSAP group were compared to the SAP group (< 24 h post-operative). Results PSAP use was 12% (155 of 1292). Patient-related factors associated with PSAP compared to the SAP group included older age (63 vs. 58y; p < 0.001), higher BMI (29 vs. 27 kg/m2; p < 0.001), ASA classification ≥3 (31% vs. 17%; p < 0.001) and lung disease (17% vs. 9%; p = 0.002). Surgery-related factors associated with PSAP were use of prosthetics (62% vs. 45%; p < 0.001), surgery of the knee (65% vs. 25%; p < 0.001), longer surgery duration (87 vs. 68 min; p < 0.001) and presence of drains (90% vs. 65%; p < 0.001). All four SSI occurred in the SAP group (0 vs. 4; p = 1.0). Surgeons administered PSAP with varying frequencies; proportions ranged from 0 to 33%. Conclusion PSAP use and SSI proportions were lower than reported in the literature. Several patient- and surgery-related factors associated with PSAP use were identified and some were potentially modifiable. Also, experienced surgeons seemed to implement differing approaches regarding the duration of SAP administration.

show abstract

“…At our institution, we previously performed quality improvement initiatives to discontinue postoperative prophylactic antibiotics for patients after craniotomies, lumbar drains, and spinal fusion in order to decrease the risk of C. Diff and MDRO infections. 16,17 After reviewing the impact of these protocols, we found that discontinuation of postoperative antibiotics did not increase the risk of meningitis or surgical wound infections. In light of these results, and the lack of data supporting the need for postoperative antibiotics after EEA, we discontinued postoperative antibiotics in this patient population.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery

Dastagirzada

Benjamin

Bevilacqua

et al. 2022

J Neurol Surg B Skull Base

Self Cite

View full text Add to dashboard Cite

Background: Postoperative prophylactic antibiotic usage for endoscopic skull base surgery varies based on institution as evidence-based guidelines are lacking. The purpose of this study is to determine whether discontinuing postoperative prophylactic antibiotics in endoscopic endonasal cases led to a difference in central nervous system (CNS) infections, multi-drug resistant organism (MDRO) infections, or other postoperative infections. Methods: This quality improvement study compared outcomes between a retrospective cohort (from September 2013 to March 2019) and a prospective cohort (April 2019 to June 2019) after adopting a protocol to discontinue prophylactic postoperative antibiotics in patients who underwent endoscopic endonasal approaches (EEAs). Our primary endpoints of the study included the presence of postoperative CNS infection, clostridium difficile (C. Diff), and MDRO infections. Results: A total of 388 patients were analyzed, 313 in the pre-protocol group and 75 in the post-protocol group. There were similar rates of intraoperative CSF leak (56.9% v. 61.3%, p=0.946). There was a statistically significant decrease in the proportion of patients receiving IV antibiotics during their postoperative course (p=0.001) and those discharged on antibiotics (p=0.001). There was no significant increase in the rate of CNS infections in the post-protocol group despite the discontinuation of postoperative antibiotics (3.5% v. 2.7%, p=0.714). There was no statistically significant difference in postoperative C. Diff (0% v. 0%, p=0.488) or development of MDRO infections (0.3% v. 0%, p=0.624). Conclusions: Discontinuation of postoperative antibiotics after EEA at our institution did not change the frequency of CNS infections. It appears that discontinuation of antibiotics after EEA is safe.

show abstract

Discontinuation of Postoperative Prophylactic Antibiotics After Noninstrumented Spinal Surgery: Results of a Quality Improvement Project

Abstract: After discontinuing PPSAs for patients with noninstrumented spinal procedures, as is recommended for quality improvement, we saw a nonsignificant increase in our rate of SSIs. Further monitoring of this population is warranted.

Cited by 6 publications

References 21 publications

Antibiotic prophylaxis practices in neurosurgery: A Society for Healthcare Epidemiology of America (SHEA) survey

Antibiotic prophylaxis practices in neurosurgery: A Society for Healthcare Epidemiology of America (SHEA) survey

Prolonged antibiotic prophylaxis use in elective orthopaedic surgery – a cross-sectional analysis

Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery

Contact Info

Product

Resources

About