Jennifer C. Urquhart, PhD, Darryl Collings, MD, Lori Nutt, RN, Linda Kuska, RN, Kevin R. Gurr, MD, FRCSC, Fawaz Siddiqi, MD, FRCSC, Parham Rasoulinejad, MD, FRCSC, Alyssa Fleming, Joanne Collie, and Christopher S. Bailey, MD, MSc, FRCSC
Summary by Amr Tawfik, BA
The use of closed suction drains frequently follows spinal surgery to reduce the risk of neurologic side effects from a compressive hematoma1, 2. However, the use of these drains has been associated with an increased risk of surgical site infection3. While clinical guidelines have recommended antibiotic prophylaxis to reduce the rate of surgical site infection, The North American Spine Society has stated that there is insufficient evidence regarding the duration of antibiotic prophylaxis following procedures that require the placement of a wound drain4, 5.
In this study, Urquhart et al. prospectively randomized 552 patients undergoing posterior thoracolumbar spinal surgery requiring a closed-suction drain to receive either 24 hours (n = 282) or 72 hours (n = 270) of postoperative antibiotic prophylaxis. They found no significant difference in deep infection rate of 6.0% and 5.2% between the 24 hour and 72 hour group, respectively (p = 0.714). They further found no significant difference in the rate of superficial infections of 9.6% and 8.1% between the 24 hour and 72 hour group, respectively (p = 0.654). Furthermore, they found that median hospital stay was one day longer for patients in the 72 hour group (p < 0.001). The authors concluded that extending postoperative prophylaxis for patients requiring closed-suction drains to 72 hours did not reduce the rate of complicated surgical site infections. Limitations of this study include that the study was not blinded, was performed at a single center, and the study surgeons did not use standardized criteria to determine which patients required a closed-suction drain.
- Andrew Glennie R, Dea N, Street JT. Dressings and drains in posterior spine surgery and their effect on wound complications. J Clin Neurosci. 2015 Jul;22(7): 1081-7. Epub 2015 Mar 25.
- Waly F, Alzahrani MM, Abduljabbar FH, Landry T, Ouellet J, Moran K, Dettori JR. The outcome of using closed suction wound drains in patients undergoing lumbar spine surgery: a systematic review. Global Spine J. 2015 Dec;5(6):479-85.
- Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayﬁeld J,Fraser VJ.Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008 Jan;90(1):62-9.
- Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, deJonge S,d eVries F,Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS; WHO Guidelines Development Group. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016 Dec;16(12):e288-303. Epub 2016 Nov 2.
- Shaffer WO, BaisdenJL, FernandR, MatzPG; NorthAmerican SpineSociety.An evidence-based clinical guideline for antibiotic prophylaxisin spine surgery. Spine J. 2013 Oct;13(10):1387-92. Epub 2013 Aug 27.