Compliance with antibiotic prophylaxis in spinal fusion surgery and surgical wound infection

Surgical wound infection is an important complication of spinal surgery. Antibiotic prophylaxis has served to decrease its rates significantly, with the ensuing reduction in hospital stay, costs, and morbidity and mortality. To date, a large assessment of the degree of compliance with antibiotic prophylaxis in spinal fusion surgery has not been undertaken in Spain with large prospective studies. We sought to assess the degree of compliance with our antibiotic prophylaxis protocol among patients who underwent spinal fusion surgery and its effect on surgical wound infection.

A prospective cohort study was carried out. Six hundred and forty patients with at least 1-year clinical followup who underwent spinal fusion surgery were included. Percentage of administration and degree of compliance with protocol was studied. Both overall and the different aspects of prophylaxis received by patients to those stipulated in the protocol in force at our hospital were compared. Percentages of compliance were assessed and the effect of prophylaxis compliance on the incidence of infection was estimated using the Relative Risk.

The study covered 640 patients. Overall compliance with the protocol was 71.5% (95% CI = 67.9- 75.1). The most frequent cause of non-compliance with the protocol was the duration of recommended antibiotic prophylaxis (77.8%). Incidence of surgical wound infection was 4.1% (95% CI: 2.5-5.5). No relationship was found between surgical wound infection and antibiotic prophylaxis non-compliance (RR 0.92, 95% CI = 0.38-2.22).

Compliance and administration of antibiotic prophylaxis were high. Surgical wound infection rate was similar to those found in the literature although there is always room for improvement.