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A single-center intervention to discontinue postoperative antibiotics after spinal fusion
Ariane Lewis1,2, Jessica Lin1, Herbert James3
1a Department of Neurology , NYU Langone Medical Center , New York , NY , USA.
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.
Insights
Discontinuing postoperative antibiotics (PA) after instrumented spinal surgery did not increase surgical site infections (SSI). Withholding PA also reduced costs and complications associated with antibiotic use.
Area of Science:
- Neurosurgery
- Infectious Disease
- Health Economics
Background:
- Postoperative antibiotics (PA) are commonly used after instrumented spinal surgery to prevent surgical site infections (SSI).
- Current medical guidelines discourage prolonged PA use until drain removal.
- Institutional policy shifted to discontinue PA for this patient population.
Purpose of the Study:
- To evaluate the impact of discontinuing postoperative antibiotics (PA) on surgical site infections (SSI) and antibiotic-related complications.
- To assess the cost-effectiveness of withholding PA in patients undergoing instrumented spinal surgery.
Main Methods:
- Retrospective review of patients undergoing instrumented spinal surgery before and after a policy change to discontinue PA.
- Comparison of SSI rates and antibiotic-related complications between PA and non-PA groups.
- Analysis of antibiotic costs and costs associated with resistant infections.
Main Results:
- No significant increase in SSI frequency was observed after discontinuing PA (2% vs. 0.6%).
- Growth of resistant bacteria showed a non-significant decrease in the non-PA period.
- Significant cost savings were achieved by withholding PA, with a median cost difference of $26.32 per patient.
Conclusions:
- Discontinuing postoperative antibiotics (PA) for instrumented spinal surgery is safe and does not increase SSI rates.
- Withholding PA may reduce complications and healthcare costs.
- Evidence supports the discontinuation of PA in this surgical population.
