Ariane Lewis1,2, Jessica Lin1, Herbert James3, Anne Clara Krok3, Nicole Zeoli2, Janine Healy2, Tyler Lewis4, Donato Pacione2. 1. a Department of Neurology , NYU Langone Medical Center , New York , NY , USA. 2. b Department of Neurosurgery , NYU Langone Medical Center , New York , NY , USA. 3. c NYU School of Medicine , New York , NY , USA. 4. d Department of Pharmacy , NYU Langone Medical Center , New York , NY , USA.
Abstract
INTRODUCTION: Postoperative antibiotics (PA) are often administered to patients after instrumented spinal surgery until all drains are removed to prevent surgical site infections (SSI). This practice is discouraged by numerous medical society guidelines, so our institutional Neurosurgery Quality Improvement Committee decided to discontinue use of PA for this population. METHODS: We retrospectively reviewed data for patients who had instrumented spinal surgery at our institution for seven months before and after this policy change and compared the frequency of SSI and development of antibiotic related complications in patients who received PA to those who did not (non-PA). RESULTS: We identified 188 PA patients and 158 non-PA patients. Discontinuation of PA did not result in an increase in frequency of SSI (2% of PA patients vs. 0.6% of non-PA patients, p = .4). Growth of resistant bacteria was not significantly reduced in the non-PA period in comparison to the PA period (2% in the PA period and 1% in the non-PA period). The cost of antibiotics for PA patients was $5,499.62, whereas the cost of antibiotics for the non-PA patients was $0. On a per patient basis, the cost associated with antibiotics and resistant infections was significantly greater for patients who received PA than for those who did not (median of $26.32 with IQR $9.87-$46.06 vs. median of $0 with IQR $0-$0; p < .0001). CONCLUSION: After discontinuing PA for patients who had instrumented spinal procedures, we did not observe an increase in the frequency of SSI. We did, however, note that there was a non-significant decrease in the frequency of growth of resistant organisms. These findings suggest that patients in this population do not need PA, and complications can be reduced if PA are withheld.
INTRODUCTION: Postoperative antibiotics (PA) are often administered to patients after instrumented spinal surgery until all drains are removed to prevent surgical site infections (SSI). This practice is discouraged by numerous medical society guidelines, so our institutional Neurosurgery Quality Improvement Committee decided to discontinue use of PA for this population. METHODS: We retrospectively reviewed data for patients who had instrumented spinal surgery at our institution for seven months before and after this policy change and compared the frequency of SSI and development of antibiotic related complications in patients who received PA to those who did not (non-PA). RESULTS: We identified 188 PApatients and 158 non-PApatients. Discontinuation of PA did not result in an increase in frequency of SSI (2% of PApatients vs. 0.6% of non-PApatients, p = .4). Growth of resistant bacteria was not significantly reduced in the non-PA period in comparison to the PA period (2% in the PA period and 1% in the non-PA period). The cost of antibiotics for PApatients was $5,499.62, whereas the cost of antibiotics for the non-PApatients was $0. On a per patient basis, the cost associated with antibiotics and resistant infections was significantly greater for patients who received PA than for those who did not (median of $26.32 with IQR $9.87-$46.06 vs. median of $0 with IQR $0-$0; p < .0001). CONCLUSION: After discontinuing PA for patients who had instrumented spinal procedures, we did not observe an increase in the frequency of SSI. We did, however, note that there was a non-significant decrease in the frequency of growth of resistant organisms. These findings suggest that patients in this population do not need PA, and complications can be reduced if PA are withheld.
Entities:
Keywords:
Antibiotic prophylaxis; fusion; spine; suction drain; surgical site infections
Authors: José Manuel Orenday-Barraza; María José Cavagnaro; Mauricio J Avila; Isabel Martha Strouse; Dara S Farhadi; Aaron Dowell; Naushaba Khan; Pedro Aguilar-Salinas; Robert Ravinsky; Ali A Baaj Journal: Eur Spine J Date: 2022-07-04 Impact factor: 2.721