INTRODUCTION
Current meta-analysis form the literature reports the expected rate of surgical site infection SSI after fusion reconstructions to be approximately 1.5%. A large literature addresses the treatment of this morbid and costly complication but investigations of prophylaxis are relatively rare. The senior author has long practiced a program of extended perioperative antibiotics administration combined with stAndard tissue handling and wound aftercare for many years and we report the results of that experience that experience here.
METHODS
Surgical logs of the senior author (DAB) were reviewed BY HIM for all cases of scheduled lumbar reconstruction with the goal of analyzing 1000 cases. Emergencies, fractures, tumors and surgery for a priori spine sepsis (ie. discitis instability) were excluded. After preliminary office-based scan of the results a database of the cases was created, Ethics Board approval for independent review was obtained, and a team of four independent observers was assigned to review all available online hospital records of the subject cases. The largest cohort subgroup was analyzed for interrater consistency.
RESULTS
Only five deep SSIs requiring operative debridement were identified. This may represent a significant decrease against the expected 15 cases expected per best-available current meta-analysis on point. There were no secondary SSIs and no uptick in expected ARO frequency in the population as followed forward.
CONCLUSION
A consistent program of SSI prophylaxis was easily administered to a large cohort over extended timeframe even in Canada's notoriously under-resourced health care system. It has produced a rate of deep SSI much lower than the expected and if applied consistently has potential to significantly decrease the care cost and morbidity of this difficult problem.