Spine J. 2023 Jul 21:S1529-9430(23)03281-3. doi: 10.1016/j.spinee.2023.07.014. Online ahead of print.
ABSTRACT
BACKGROUND CONTEXT: Postoperative incisional concerns including non-purulent drainage are relatively common following spine surgery. Evidence-based management protocols are lacking.
PURPOSE: The purpose of this study is to determine if prescribing empiric oral antibiotics for non-purulent wound drainage is beneficial for the prevention of chronic infection or reoperation.
STUDY DESIGN: Retrospective chart review PATIENT SAMPLE: Patients calling the office with post-surgical wound concerns OUTCOME MEASURES: Not applicable METHODS: In a large, multi-surgeon, spine surgery practice, review of the communications log showed that 298 patients called or messaged the office with a concern regarding postoperative non-purulent wound drainage. Patients were prescribed empiric oral antibiotics based on surgeon preference. Patients who received empiric oral antibiotic treatment (AbxTx) were propensity matched to patients who did not (No AbxTx) based on sex, age, BMI, ASA grade, smoking status, prior spine surgery, anatomic location, and number of surgical levels. The number of patients requiring surgical intervention (debridement) and/or developing a chronic infection were determined.
RESULTS: Oral antibiotics were prescribed for 112 of the 298 (38%) of the patients with reports of non-purulent drainage. Demographic and surgical characteristics of the two matched cohorts were similar. Although there were more patients in the AbxTx group who required surgical intervention (n=17, 17%) compared to the No AbxTx group (n=9, 9%), this difference was not statistically significant (p=0.139). The intra-operative culture results showed no growth in 94% (16/17) of the AbxTx group versus 67% (6/9) of the No AbxTx group (p=0.103). One patient in each group required a return to the operating room within the year after the initial surgical debridement for management of chronic infection.
CONCLUSION: In this large series (n=298) of patients with non-purulent wound drainage following spine surgery, 87% resolved without the need for surgical intervention. Empiric oral antibiotics did not reduce the need for surgical intervention or the development of a chronic infection. In addition to added cost, potential adverse reactions, development of resistant organisms, and inaccurate labeling of surgical site infection; empiric oral antibiotics may lead to a negative intra-operative culture for those requiring surgical intervention impacting the ability to prescribe a specific antibiotic regimen.
PMID:37482252 | DOI:10.1016/j.spinee.2023.07.014
