Introduction: Surgical site infection (SSI) occurs after approximately 4% of degenerative lumbar spine cases and higher for complex spine
surgery, including surgery for adult spinal deformity. It remains imperative to develop methods to reduce the incidence of SSI
Methods: After institutional review board approval, we retrospectively
examined 1,089 consecutive lumbar spine surgeries performed
between August 1, 2014 and August 1, 2016. Surgeons elected
whether or not to use a peri-operative infection control protocol
which included: (1) three days of chlorhexidine rinse prior to
surgery; (2) chlorhexidine pre-prep scrub of the surgical site; (3)
chlorhexidine prep with a 5-minute mandatory wait time; (4)
intrawound vancomycin powder; and (5) iodine-impregnated antimicrobial
film bandage. Nearest-neighbor propensity matching was
performed according to demographic (age, sex, body mass index,
co-morbidities, ASA grade, active smoking status) and surgical
(operative time, estimated blood loss, number of levels fused)
parameters. Statistical significance was p<.05 with a two-tailed ttest.
Results: 592 patients underwent surgery with this protocol, while 443
patients underwent only chlorhexidine prep. 446 patients (257 with
protocol; 189 without) underwent lumbar decompressions. 589
patients (448 with protocol; 141 without) underwent lumbar fusion,
with 54 patients (36 with protocol; 18 without) undergoing lumbar
fusion involving six or more levels. Overall SSI rate was 1.1%
(0.3%, decompression; 1.6%, fusion; 3.2%, fusion = six levels).
SSI rate with the protocol was 0.9% (0.3%, decompression; 1.1%,
fusion; 2.1%, fusion = six levels) compared to 1.3% without the
protocol (0.3%, decompression; 1.9%, fusion; 4.1%, fusion = six
levels). Multivariate regression analysis after propensity matching
revealed a statistically significant difference in SSI rates for
patients undergoing fusion involving six or more levels (p<.05),
with a trend towards significance for all lumbar fusions.
Conclusions: A rigorous SSI prevention protocol can reduce infection rates,
particularly in complex cases. Multi-institutional assessment will be essential to further corroborate its efficacy.
Patient Care: This research will help reduce the incidence of surgical site
infection after lumbar spine surgery.
Learning Objectives: By the conclusion of this session, participants should be able to 1)
Describe the risk factors for surgical site infection after lumbar
spine surgery; 2) Discuss preventative strategies to reduce the risk of infection; and 3) Identify strategies for the implementation of an infection control and prevention protocol at their own institutions