Perioperative Prophylactic Cephazolin in Spinal Surgery. A Double-Blind, Placebo-Controlled Trial

Rubinstein, Ethan; Findler, Gideon; Amit, Priyadarshi; Shaked, Izhak

doi:10.1097/00019048-199407000-00023

Cited by 22 publications

(38 citation statements)

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“…Among the laboratory parameters, ESR and CRP level surgical site infection rate. For example, the rate of surgical site infection in lumbar spine surgery has been reported as 1% to 4% with prophylactic antibiotics and 6% to 13% without them 3,20) . However, the proper duration of such antibiotic usage has long been a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Chung

Won

Kwon

et al. 2011

J Korean Neurosurg Soc

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in a single institution. Exclusion criteria were as follows : preceding the spine surgery in the previous 2 weeks, preexisting or postoperative infection, being less than 18 years of age, and being discharged less than 5 days after the spinal surgery. Clinical data relevant to the study included age, sex, body mass index (BMI), BT, site and type of surgery, and surgery duration.All patients received a preoperative antibiotic prophylaxis with a first generation cephalosporin, cefazolin, and also postoperative antibiotics were injected through their fourth postoperative day. All patients were operated under general anesthesia and received daily clinical examinations until discharge. INTRODUCTIONDespite advances in prophylaxis, the incidence of deep infection after instrumented spinal surgery remains between 0.4% and 4.3% 14,16,19) and may be higher in patients undergoing fusion after spinal trauma 26) . Although infection can be a disabling complication of any surgical procedure, spinal infection can be particularly devastating due to the close proximity of the neurological structures. Early detection of an infection may prevent substantial problem later.It is often difficult to diagnose postoperative spinal infection before clinical symptoms become apparent. Magnetic resonance imaging can help to diagnose the soft-tissue change but is expensive to use as a screening tool and may not be available. Although inflammatory markers, such as C-reactive protein (CRP), white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and body temperature (BT), easily are measured, their specificities are not high.In a recent meta-analysis, procalcitonin (PCT) was superior to Objective : Classical markers of infection cannot differentiate reliably between inflammation and infection after neurosurgery. This study investigated the dynamics of serum procalcitonin (PCT) in patients who had elective spine surgeries without complications. Methods : Participants were 103 patients (47 women, 56 men) who underwent elective spinal surgery. Clinical variables relevant to the study included age, sex, medical history, body mass index (BMI), site and type of surgery, and surgery duration. Clinical and laboratory data were body temperature, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and PCT, all measured preoperatively and postoperatively on days 1, 3, and 5. Results : PCT concentrations remained at <0.25 ng/mL during the postoperative course except in 2 patients. PCT concentrations did not correlate with age, sex, DM, hypertension, BMI, operation time, operation site, or use of instrumentation. In contrast, CRP concentrations were significantly higher with older age, male, DM, hypertension, longer operation time, cervical operation, and use of instrumentation. Conclusion : PCT may be useful in the diagnosing neurosurgical patients with postoperative fever of unknown origin.

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Section: Discussionmentioning

confidence: 99%

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Chung

Won

Kwon

et al. 2011

J Korean Neurosurg Soc

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“…Under such conditions, the overall infection rate in group 2 (3.4%), with one superficial wound infections (0.5%) and six deep wound infections (2.9%), was comparable to previous reports. [3][4][5][6][7][8][9][10][11] Group 1 patients, who received betadine solution irrigation, had no postoperative infection during the follow-up period. The difference in the incidence of deep infection in our two groups was statistically significant (P ϭ 0.0146), whereas that of superficial infection was not significant (P ϭ 0.4976).…”

Section: Discussionmentioning

confidence: 99%

“…Prophylactic antibiotics have markedly reduced the rate of deep wound infection. [3][4][5][6][7][8][9][10][11] In a recent meta-analysis, infection rates were 2.2% in patients treated with prophylactic antibiotics versus 5.9% without. 10 Effort has been directed towards identifying preoperative, intraoperative, and postoperative risk factors that correlate with infection following spinal surgery 3,4,[7][8][9][11][12][13][14][15][16][17][18][19] .…”

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confidence: 99%

Efficacy of Dilute Betadine Solution Irrigation in the Prevention of Postoperative Infection of Spinal Surgery

Cheng¹,

Chang²,

Wang³

et al. 2005

Spine

217

149

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Our report is the first prospective, single-blinded, randomized study to evaluate the clinical effectiveness of dilute betadine solution irrigation for prevention of wound infection following spinal surgery. We recommended this simple and inexpensive measure following spinal surgery, particularly in patients with accidental wound contamination, risk factors for wound infection, or undergoing surgery in the absence of routine ultraviolet light, laminar flow, and isolation suits.

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“…Limited evidence is provided for the use of antibiotics [57], not to shave the skin [10], and for bactericidal wound irrigation in addition to antibiotics [12]. A Cochrane Review [51] concluded that there is moderate evidence not to use wound suction drains.…”

Section: Resultsmentioning

confidence: 99%

The contribution of RCTs to quality management and their feasibility in practice

Brox

2009

Eur Spine J

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The randomized controlled trial (RCT) is generally accepted as the most reliable method of conducting clinical research. To obtain an unbiased evaluation of the effectiveness of spine surgery, patients should be randomly assigned to either new or standard treatment. The aim of the present article is to provide a short overview of the advantages and challenges of RCTs and to present a summary of the conclusions of the Cochrane Reviews in spine surgery and later published trials in order to evaluate their contribution to quality management and feasibility in practice. From the searches, 130 RCTs were included, 95 from Cochrane Reviews and systematic reviews, and 35 from additional search. No study comparing surgery with sham surgery was identified. The first RCT in spine surgery was published in 1974 and compared debridement and ambulatory treatment in tuberculosis of the spine. The contribution of RCTs in spinal surgery has markedly increased over the last 10 years, which indicates that RCTs are feasible in this field. The results demonstrate missing quality specifications. Despite the number of published trials there is conflicting or limited evidence to support various techniques of instrumentation. The only intervention that receives strong evidence is discectomy for faster relief in carefully selected patients due to lumbar disc prolapse with sciatica. For future trials, authors, referees, and editors are recommended to follow the CONSORT statement. RCTs provide evidence to support clinical opinions before implementation of new techniques, but the individual clinical experience is still important for the doctor who has to face the patient.

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Perioperative Prophylactic Cephazolin in Spinal Surgery. A Double-Blind, Placebo-Controlled Trial

Cited by 22 publications

References 0 publications

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Efficacy of Dilute Betadine Solution Irrigation in the Prevention of Postoperative Infection of Spinal Surgery

The contribution of RCTs to quality management and their feasibility in practice

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