Implementing a Multidisciplinary Clinical Pathway Can Reduce the Deep Surgical Site Infection Rate After Posterior Spinal Fusion in High-Risk Patients

Glotzbecker, Michael P.; Troy, Michael; Miller, Patricia E.; Berry, Jay G.; Cohen, Lara Langer; Gryzwna, Alexandra; McCann, Mary Ellen; Hresko, M. Timothy; Goobie, Susan M.; Emans, John B.; Brustowitz, Robert; Snyder, Brian D.; Hedequist, Daniel

doi:10.1016/j.jspd.2018.06.010

Cited by 28 publications

(31 citation statements)

References 38 publications

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“…17 , applying a care protocol including postoperative wound education and dressing management at discharge, found a trend towards reduced SSI rate in pediatric patients undergoing spinal fusion. Glotzbecker et.al., 47 in a retrospective cohort study of high-risk pediatric patients undergoing multi-level posterior spinal fusion, similarly found no difference in overall rate of SSI when a multidisciplinary infection-specific pathway was implemented.…”

Section: Q4b Does Concomitant Administration Of Amp In the Presence mentioning

confidence: 96%

“…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).…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…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). 17 of 30 12,15,18,21,22,[24][25][26]31,32,35,40,42,43,45,47,48 There is insufficient evidence to provide recommendations on postoperative AMP administration to reduce the rate of SSI in other types of spine surgery.…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…The findings of the evidence review and GRADE for SSI reduction are shown in Evidence 16,17,26,46,47 investigated the implementation of care pathways or protocols and its impact on SSI. At the outcome level, very low-quality evidence indicates no difference in overall SSI rate with implementation of infection-specific protocols.…”

Section: Q4b Does Concomitant Administration Of Amp In the Presence mentioning

confidence: 99%

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

et al. 2020

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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

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Section: Q4b Does Concomitant Administration Of Amp In the Presence mentioning

confidence: 96%

Section: General Study Characteristicsmentioning

confidence: 99%

Section: General Study Characteristicsmentioning

confidence: 99%

Section: Q4b Does Concomitant Administration Of Amp In the Presence mentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

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“…OR infection is the most critical and potentially the most dangerous component of nosocomial infections [1,5,8,9]. Therefore, effective and stringent infection prevention management during surgery is extremely important for the prevention of OR and even nosocomial infections.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of infection control pathway in reducing postoperative infections in patients undergoing neurosurgery

Dong

Yuan

Ren

et al. 2020

J Infect Dev Ctries

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Introduction: The environment of the operating room (OR) is closely related to the postoperative complications of patients, and it is necessary to study, to what extent, the stringent management of the OR can reduce postoperative complications. Methodology: 426 patients who underwent surgery between January 2016 and December 2017 were selected from two class-100 laminar flow ORs of equivalent area, and were divided into an experimental group and a control group. Results: The experimental group had significantly lower total air-borne bacterial count in the OR than the control group 10 minutes before surgery (6.21 ± 4.14 vs. 11.58 ± 5.36 CFU/cm3), 10 minutes (15.67 ± 6.21 vs. 20.83 ± 5.78 CFU/cm3), 30 minutes (27.34 ± 8.18 vs. 39.56 ± 7.86 CFU/cm3) and 60 minutes (43.62 ± 7.66 vs. 51.63 ± 8.43 CFU/cm3) into surgery, and at the end of surgery (57.34 ± 7.67 vs. 69.33 ± 9.41 CFU/cm3) (all p < 0.05). The incidence rates of increased body temperature and leukocyte count 3 days post-surgery, and the duration of antibiotic therapy and hospital stay were significantly reduced in the experimental group compared to the control group (all p < 0.05). Furthermore, the total number of pathogens in the incision at 2 hours into surgery was also significantly lower in the experimental group than in the control group (p < 0.05). Conclusion: Stringent application of the infection control pathway is an efficacious measure for improving the air cleanliness of the neurosurgery OR, decreasing the incidence rates of postoperative complications and infection, as well as controlling pathogen transmission.

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Postoperative Infection in Early-Onset Scoliosis

2022

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Implementing a Multidisciplinary Clinical Pathway Can Reduce the Deep Surgical Site Infection Rate After Posterior Spinal Fusion in High-Risk Patients

Cited by 28 publications

References 38 publications

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

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

Efficacy of infection control pathway in reducing postoperative infections in patients undergoing neurosurgery

Postoperative Infection in Early-Onset Scoliosis

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