December 9, 2022

Routine use of antibiotics after spine surgery may not be warranted

José Orenday-Barraza (left) and Ali Baaj (right)

According to a recent systematic review and meta-analysis published in the European Journal of the Spine by José Orenday-Barraza and Ali Baaj (University of Arizona College of Medicine, Phoenix, USA) et al.

The study aimed to determine whether or not the published literature supports the current practice of postoperative antibiotic use in spine surgery.

A systematic review of the PubMed and Cochrane Central Register of Controlled Trials databases was performed. The search terms used were: “Antibiotic prophylaxis” [Mesh]antibiotic*, antibacterial*, “Rachis” [Mesh]”Surgical, Operative Procedures” [Mesh].

Only comparative clinical studies were included and studies with SSI criteria that were not similar to the US Center for Diseases Control and Prevention definition were excluded.

A meta-analysis for all SSIs was performed. A subgroup analysis was also performed to analyze the results specifically on the groups of instrumented patients. A random-effects model was used to calculate the relative risks (RR). Forest plots were used to display RR and 95% confidence intervals (CI).

A total of 13 studies were included of which four were randomized controlled trials, three were prospective cohorts and six were retrospective.

Three different perioperative strategies were used in the selected studies:

  • Group 1: Preoperative administration of antibiotics (PreopAbx) versus PreopAbx and any type of postoperative administration of antibiotics (Pre + postopAbx) (n = 6 studies; 7849 patients)
  • Group 2: Abx pre+postop ≤24 hours versus Abx pre+postop >24 hours (n=6; 1,982)
  • Group 3: Abx pre + postop ≤ 48 hours versus Abx pre + postop ≤ 72 hours (n = 1; 502)

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).

Talk to Spine News International, Orenday-Barraza said, “Preoperative prophylaxis with antibiotics has been shown to reduce the risk of spinal infection after surgery. However, postoperative antibiotic prophylaxis has also been commonly used by spine surgeons without clear evidence of improved outcomes.

“This meta-analysis, which also compares subgroups with and without instrumentation, showed that there is no difference in the number of surgical site infections whether antibiotics are used postoperatively or nope. These findings could have a significant impact on the healthcare community by potentially reducing length of stay and costs, and it also prompts further clinical trials.

“I applaud José Orenday-Barraza for conducting this impactful research. With cost and safety at stake, it is imperative that we tailor postoperative antibiotic use appropriately after spine surgery,” Baaj added.