Routine use of postoperative antibiotics in spine surgery may not be effective in preventing surgical site infections (SSIs), according to a recent systematic review and meta-analysis which was published in the European Spine Journal by José Orenday-Barraza and Ali Baaj (University of Arizona College of Medicine, Phoenix, USA) et al.
The study sought to determine whether or not the published literature supports the current practice of utilising antibiotics postoperatively in spine surgery.
A systematic review from the PubMed and Cochrane Central Register of Controlled trials databases was performed. The search terms used were: “Antibiotic Prophylaxis” [Mesh], antibiotic*, antibacterial*, “Spine” [Mesh], “Surgical Procedures, Operative” [Mesh].
Only comparative, clinical studies were included and those studies with SSI criteria that were not similar to the US Center for Diseases Control and Prevention definition were excluded.
A meta-analysis for overall SSI was performed. A subgroup analysis was also performed to analyse the outcomes specifically on instrumented groups of patients. A random-effects model was used to calculate risk ratios (RRs). Forest plots were used to display RR and 95% confidence intervals (CIs).
A total of 13 studies were included of which four were randomised controlled trials, three were prospective cohorts, and six were retrospective.
Three different perioperative strategies were used in the selected studies:
- Group one: Preoperative antibiotic administration (PreopAbx) versus PreopAbx and any type of postoperative antibiotic administration (Pre + postopAbx) (n=6 studies; 7,849 patients)
- Group two: Pre + postopAbx ≤24 hours versus Pre + postopAbx >24 hours (n = 6; 1,982)
- Group three: Pre + postopAbx ≤48 hours versus Pre + postopAbx ≤72 hours (n = 1; 502)
The meta-analysis performed on Groups one and two did not show significant effects (RR=1.27, 95% CI = 0.77, 2.09, and RR=0.97, 95% CI = 0.64, 1.46, respectively).
Speaking to Spinal News International, Orenday-Barraza said: “Preoperative prophylaxis with antibiotics has been demonstrated to reduce the risk of spine infection after surgery. However, postoperative antibiotic prophylaxis has also been routinely used by spine surgeons without clear evidence of improved outcomes.
“This meta-analysis, which also compares subgroups with and without instrumentation, has shown that there is no difference in the number of surgical site infections whether you use antibiotics postoperatively or not. These results could have a great impact on the healthcare setting by potentially reducing the length of stay and costs, and it also incentivises further clinical trials.”
“I applaud José Orenday-Barraza for carrying out this impactful research. With costs and safety at stake, it is imperative we tailor postoperative antibiotic utilisation appropriately after spine surgery,” added Baaj.