Does intraoperative antiseptic solution soaking reduce microbial contamination in spine surgery? A randomized...

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Antimicrobial Agents

Background:

• Surgical site infections (SSIs) are a significant complication in instrumented spine surgery, increasing patient morbidity and healthcare costs.
• Standard preoperative disinfection protocols do not fully eliminate bacterial contamination, necessitating further preventative strategies.
• The comparative efficacy of different intraoperative antiseptic solutions for reducing contamination in spine surgery is not well-established.

Purpose of the Study:

• To evaluate the effectiveness of intraoperative antiseptic solution soaking using normal saline (NS), povidone-iodine (PVP-I), and chlorhexidine gluconate (CHG) in reducing bacterial contamination.
• To assess bacterial reduction on superficial tissues, deep tissues, and implant surfaces during lumbar instrumented fusion surgery.
• To compare the incidence of postoperative SSIs and clinical complications across the different antiseptic groups.

Main Methods:

• A single-center, single-blinded, randomized controlled trial involving 105 patients undergoing posterior lumbar interbody fusion.
• Patients were randomized into three groups: normal saline (NS), povidone-iodine (PVP-I), or chlorhexidine gluconate (CHG), each receiving a 3-minute soak.
• Intraoperative swab samples were collected from three sites pre- and postirrigation for bacterial culture and 16S rRNA PCR analysis.

Main Results:

• Normal saline showed no significant bacterial reduction. Povidone-iodine demonstrated a reduction in superficial contamination but not in deeper tissues or implants.
• Chlorhexidine gluconate (CHG) exhibited the greatest bacterial reduction, significantly outperforming both NS and PVP-I on implant surfaces.
• Despite significant differences in bacterial reduction, postoperative SSI rates were low and comparable across all groups, with no antiseptic-related complications.

Conclusions:

• Bacterial contamination persists in lumbar fusion surgery even with standard disinfection; intraoperative antiseptic irrigation can further reduce this burden.
• Chlorhexidine gluconate (CHG) is superior to normal saline and povidone-iodine in reducing bacterial contamination, particularly on implant surfaces.
• CHG shows promise as an intraoperative antiseptic for spine surgery, warranting further multi-center studies to confirm its impact on SSI reduction and long-term outcomes.