Postoperative Prophylactic Antibiotics in Spine Surgery: A Propensity-Matched Analysis

Area of Science:

• Spine Surgery
• Infectious Disease
• Clinical Outcomes

Background:

• Surgical site infections (SSIs) are a significant complication following spine surgery, increasing healthcare costs.
• Prophylactic antibiotics are standard, but optimal duration remains unclear.
• This study addresses the impact of postoperative antibiotic duration on infection rates.

Purpose of the Study:

• To investigate if administering prophylactic antibiotics for 24 hours postoperatively affects surgical site infection rates compared to preoperative administration only.
• To evaluate the safety of extended postoperative antibiotic use regarding Clostridium difficile and multidrug-resistant organism infections.

Main Methods:

• Retrospective analysis of 4,454 patients undergoing inpatient spinal procedures from 2011-2018.
• 1:1 nearest-neighbor propensity score matching was used to compare patients who received postoperative antibiotics versus those who did not.
• Multivariable logistic regression controlled for confounding factors, with a minimum 1-year follow-up.

Main Results:

• No significant difference in infection rates was observed between patients receiving 24 hours of postoperative antibiotics (1.8%) and those who did not (1.5%).
• Postoperative antibiotic use did not significantly decrease the odds of infection (OR = 1.17; p = 0.628).
• No increased risk of Clostridium difficile infection or multidrug-resistant organism infections was noted with extended antibiotic use.

Conclusions:

• Administering 24 hours of postoperative antibiotics does not alter surgical site infection rates in spine surgery.
• Prolonged prophylactic antibiotic use in this context does not appear to increase the risk of adverse infectious outcomes.