Neurosurgeon Ascention Saint Vincent - Indianapolis/Goodman Campbell Brain & Spine Carmel, Indiana, United States
Introduction: Postoperative infection remains prevalent after major deformity correction. Few studies have examined infection rate specifically after major spinal deformity correction, however an 8.9% rate of infection following posterior long-segment fusion was determined in a recent retrospective study. Institutional protocols for infection prevention have been shown to improve rates of infection after spine surgery. The aim of this study was to determine the efficacy of a multi institutional intraoperative sodium oxychlorosene–based infection prevention protocol for decreasing the rate of infection after instrumented spinal deformity correction.
Methods: A multi-modal infection prevention protocol based on intraoperative sodium oxychlorosene and vancomycin powder use, daily hibiclens wound care, and dressing changes was adopted at two tertiary care institutions with active spinal deformity programs. A retrospective analysis was performed of patients who underwent posterior instrumented spinal fusion of the thoracic or lumbar spine, four or more levels, for deformity correction between January 1, 2011, and May 31, 2019. An infection rate for these patients, and possible adverse outcomes related to infection prevention techniques, were captured.
Results: A total of 254 patients fit the inclusion criteria. Of these patients, 9 (3.5%) experienced post-surgical deep-wound infection. In the 226 patients who met the follow up criteria, the fusion rate was 84.1%, comparing favorably with literature pseudoarthrosis rates. Patients that required wound washout were more likely to have diabetes than non-infected patients (33.3% vs 12.9%). Infected patients had higher average BMI (32.66) than the entire group (30.36), and were more likely to be female (77.8% vs. 62.6%). 41 patients were smokers (16.3%) and 85 were former smokers (33.7%). No infected patients were active smokers at the time of surgery, however 4, (44.4%) were former smokers.
Conclusion : An intraoperative comprehensive sodium oxychlorosene–based infection prevention protocol helped to significantly decrease the rate of infection after major deformity correction without negatively impacting postoperative procedure-related metrics.
