Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

Abstract

Background: Multiple measures prior to spine surgery may reduce the risks of postoperative surgical site infections (SSIs). Methods: The incidence of SSI following spinal surgery (including reoperations and readmissions) may be markedly reduced by performing less extensive procedures and avoiding fusion where feasible. Preoperative testing up to 3 weeks postoperatively should include other studies to limit the perioperative SSI risk; cardiac stress tests (e.g., older patients/cardiac comorbidities), starting tamsulosin in males over 60 (e.g. avoid urinary retention due to benign prostatic hypertrophy), albumin/prealbumin levels (e.g., low levels increase SSI risk), and HBA1C levels to identify new/treat known diabetics (normalize/reduce preoperative levels). Results: Other measures include the timely administration of preoperative antibiotics (e.g., cefazolin 2 g nonpenicillin allergic), one dose of gentamicin (adjusted dose/weight), nasal cultures for methicillin-resistant Staphylococcus aureus (patients/health-care workers), and bathing 2 weeks preoperatively with chlorhexidine gluconate 4% (not just night before/morning of surgery). Additionally, prior to surgery, the following medications that increase the bleeding risk should be stopped (e.g. for varying periods); anticoagulants, antiplatelet therapies (e.g., aspirin for at least 7–10 days), nonsteroidal anti-inflammatories (NSAIDS: timing depends on the drug), vitamin E, and herbal supplements. Additionally, avoiding elective spinal surgery in morbidly obese patients and recognizing other major medical contraindications to spinal surgery should help reduce infection, morbidity, and mortality rates. Conclusions: Appropriate preoperative and intraoperative prophylactic maneuvers may reduce the risk of postoperative spinal SSI. Specific attention to these details may avoid infections and improve outcomes.

Development of a nomogram to predict surgical site infection after closed comminuted calcaneal fracture

“…In this study, prealbumin levels were significantly lower in the SSI group than in the non-SSI group (228.70 versus 262.62 p = 0.001), and prealbumin levels in the SSI group were lower than usual, indicating poor preoperative nutritional status in the SSI group. An increasing body of evidence [20,21] substantiates low albumin levels as a risk factor for SSI after spinal surgery. Similarly, low prealbumin levels have been reported as a risk factor for SSI in patients with Crohn's disease after intestinal resection [22].…”

Clostridium perfringens in the spine: A rare cause of post-surgical infection

“…As these lesions may prove fatal, they typically warrant emergent surgical debridement/wash-out, continued negative pressure drainage, and appropriate antibiotic therapy. [ 7 , 8 , 9 ]…”

Surgical Site Infection: Impacts and Challenges of Antibiotic Rationalism

“…Diabetes is one of the most devastating factors for processing dirty wound. Smoking is also a factor for making Peripheral Vascular Disease like Burger's disease [21,22]. But the shocking cause was use of antibiotics irrationally or incomplete dosage.…”