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  • Reduced Rate of Surgical Site Infections following Cervical and Lumbar Spine Surgery using an Enhanced Prophylaxis Protocol

    Final Number:

    Tanvir Choudhri MD; Jonathan Rasouli; Alexa Dessy BS; Frank Yuk; James Connolly; John Nathanson BS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Surgical site infections (SSI) remain a relatively common complication of spine surgery, leading to increased morbidity/mortality, length of hospital stay, readmission rate and healthcare costs. In previous studies, the incidence of SSI reported following spinal surgery ranges from 0.25-4.2%. In particular, the reported rate of infection ranges from 1.9-4.0% for cervical spine surgery (CSS) and 0.3-8.5% for lumbar spine surgery (LSS). This study investigates the effect of an enhanced prophylaxis protocol on the incidence of SSI in CSS and LSS.

    Methods: This retrospective study analyzed CSS and LSS procedures performed by a single neurosurgeon at one institution from October 2001 to November 2013 (n=826). Patients with known preexisting infection (e.g. osteomyelitis or epidural abscess) were excluded. From October 1, 2001 to December 1, 2005, the standard institutional prophylaxis protocol was followed. After December 1, 2005, an enhanced prophylaxis protocol was implemented and consistently followed. Under the enhanced protocol a special prep was performed, generally by the attending surgeon. Other techniques were followed for select cases (will be explained during presentation).

    Results: The overall rate of SSI following cervical and lumbar spine surgery was 0.6% (0.5% for CSS and 0.8% for LSS). Using the enhanced protocol, the incidence of SSI was significantly reduced from 1.5% (standard protocol) to 0% (enhanced protocol, p=0.0098). Similarly, the incidence of SSI following CSS was significantly reduced from 1.6% to 0% (p=0.0317). Although it did not reach statistical significance, the incidence of SSI following LSS was reduced from 1.4% to 0% (p=0.5112).

    Conclusions: The results provide evidence that the enhanced protocol was effective in reducing the incidence of SSI following spine surgery. Further studies are needed to examine which aspects of the enhanced prophylaxis protocol are responsible for the reduction in the rate of SSI following spine surgery.

    Patient Care: Minimizing/avoiding complications related to surgical procedures is an important goal to help improve patient outcomes and reduce health care costs. This study will hopefully add to efforts to reduce the incidence of surgical site infections following spine surgery.

    Learning Objectives: By the conclusion of the presentation, participants should be able to (1) Discuss the incidence of surgical site infections after spine surgery (2) Understand potential risks factors for surgical site infections following spine surgery, some of which may be modifiable,


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