Prevention of Surgical Site Infections in Adult Spine Surgery

Although measures have been taken to decrease its occurrence, surgical site infection (SSI) continues to be a frequent and expensive complication of spinal surgery in adults. SSI has been found to be linked with longer hospital stays, higher rates of illness or disease, and increased risk of death.

The Society for Healthcare Epidemiology of America (SHEA) has made an estimation that evidence-based guidelines can prevent up to 60% of SSIs. Proactive measures should be considered during the preoperative, intraoperative, and postoperative phases to lower the incidence of SSI.

Intrawound Vancomycin Powder

The consensus of experts suggests that the application of vancomycin powder directly into a wound can lower the occurrence of surgical site infections.

Perioperative Antibiotic Prophylaxis

Giving a preoperative single dose of antibiotics decreases SSI rates compared to not giving any antibiotics. However, in non-instrumented lumbar spine surgery, giving multiple doses of antibiotics during the perioperative period does not impact SSI rates compared to giving a single preoperative dose.

Similarly, in instrumented lumbar fusion surgery, giving multiple doses of antibiotics during the perioperative period does not affect SSI rates compared to a single preoperative dose of antibiotics. When a single preoperative dose of antibiotics is given, administering postoperative antibiotics for three or more days does not impact SSI rates compared to administering postoperative antibiotics for only two days.

Closed Suction Wound Drainage

The utilization of a sealed suction drain for wound drainage does not impact the incidence of surgical site infections (SSIs).

Povidone-Iodine Solution Irrigation

The application of a 0.35% solution of povidone-iodine for wound irrigation diminishes the occurrence of surgical site infections (SSIs).

2-Octyl-Cyanoacrylate Skin Closure

According to the literature, the usage of 2-octylcyanoacrylate for skin closure results in lower surgical site infection (SSI) rates when compared to sutures or staples for skin closure. The safety record of intrawound vancomycin seems to be excellent, with a minimal occurrence of negative health outcomes.

With intrawound vancomycin usage in lumbar spine surgery, the incidence of negative outcomes is just 0.3%. The formation of a seroma is the most frequent complication. Likewise, in the pediatric spine literature, the treatment is deemed safe, with no indication of nephrotoxicity and non-toxic serum levels. A trend towards an increased incidence of gram-negative or polymicrobial infections has been noted.

Before a surgical operation, it is recommended to administer antibiotics to prevent infections. This practice is known as preoperative antibiotic prophylaxis and is a crucial component of the Surgical Care Improvement Project (SCIP), which aims to decrease surgical complications and fatalities.

The National Surgical Infection Prevention Project introduced this measure, and the North American Spine Society (NASS) Clinical Guidelines also recommend its use.

The NASS Clinical Guidelines reflect the consistent evidence that non-instrumented lumbar spine surgeries require only one preoperative intravenous (IV) antibiotic dose. This approach has been shown to be effective in multiple studies. As part of the SCIP measures, it is recommended to stop administering antibiotics within 24 hours of the surgical end time.

This is to prevent the unnecessary use of antibiotics, which can lead to the development of antibiotic-resistant bacteria. Literature has reported that administering antibiotics for an extended period after surgery while a drain is present can lower the incidence of surgical site infections (SSIs) in mastectomy and ventral hernia repair procedures.

Although closed suction wound drainage may not be necessary to prevent surgical site infections, it may still be suitable for other purposes, such as preventing hematoma formation.

Basic science studies have raised concerns about the potential neurotoxic effects of povidone-iodine in cases of dural injury. As a result, it has been recommended that povidone-iodine irrigation should be avoided in cases involving intradural work or dural tear. Furthermore, laboratory studies have demonstrated that povidone-iodine has cytotoxic effects on various types of cells, including osteoblasts, chondrocytes, fibroblasts, and mesenchymal stromal cells.

When compared to suture alone, the use of 2-octyl-cyanoacrylate in addition to suture for skin closure during cardiac surgery has been found to decrease the incidence of surgical site infections (SSIs). However, in studies involving open colectomy or total joint arthroplasty, the use of 2-octyl-cyanoacrylate did not result in a significant difference in SSI rates compared to the use of staples.

The majority of the available literature on the use of laminar airflow systems in the operating room has focused on orthopedic surgery, particularly total joint arthroplasty. Additionally, most of these studies have evaluated the effectiveness of combining laminar airflow systems with total body exhaust gowns.

Studies in the literature have indicated that the use of laminar airflow systems in the operating room can reduce the incidence of periprosthetic joint infections. However, some studies have also found a significant increase in surgical site infection rates associated with the use of laminar airflow systems.

The available literature from various disciplines suggests that preoperative hair removal through shaving is associated with an increased risk of surgical site infections (SSIs). Compared to shaving, methods such as clipping, chemical depilation, or no hair removal have significantly lower rates of surgical site infections (SSIs).

The increased risk of surgical site infections (SSIs) associated with razor use is believed to be due to a greater likelihood of injury to the skin barrier, which can lead to bacterial colonization. Additionally, if razors are reused and not properly sterilized, there is a risk of cross-contamination.

According to literature, a prospective randomized study conducted on patients undergoing radical cystectomy found that those who received total parenteral nutrition (TPN) in addition to their regular enteric intake had a higher incidence of surgical site infections (SSIs) and other infectious complications compared to the group who received enteric intake alone.

Despite the fact that the TPN group had their nutritional parameters restored earlier, the risk of infection was higher. The use of parenteral nutrition is associated with an increased risk of infectious complications, which is believed to be caused by multiple factors. This risk can potentially offset any benefits that may result from the accelerated recovery of nutritional parameters.

In regards to tissue that has been previously irradiated, the wound healing process may benefit from the vasodilatory effects of PGE. The use of incisional negative pressure wound therapy (NPWT) has been shown to decrease the incidence of surgical site infections (SSIs) in various surgical fields.

Silver is recognized for its antimicrobial characteristics, and, as a result, dressings that are impregnated with silver have been employed for a significant amount of time to prevent or treat infections in acute or chronic open wounds.

Triclosan is a type of antimicrobial substance that has an effect on both gram-positive and gram-negative bacteria, and is employed in a broad range of healthcare products. Coating sutures with antimicrobial agents has generated significant interest. The use of triclosan-coated sutures has been associated with a decrease in surgical site infections (SSI).

Previous studies in hip arthroplasty literature have demonstrated that regular glove replacement can reduce glove perforation and contamination. Similarly, in the spine literature, this practice has also been shown to be effective.

The use of surgical drapes impregnated with iodine is believed to aid in the prevention of surgical site infections (SSI) by decreasing contamination of the wound by skin flora, in addition to providing an antimicrobial effect.

The majority of prophylactic measures investigated thus far in adult spine surgery have been previously studied in other medical specialties for the prevention of surgical site infections (SSI) and were often initially developed and tested in those fields.

Proactive strategies that are currently under evaluation in other surgical fields, like the use of gentamicin-collagen sponges or antimicrobial skin sealants, are potential areas of investigation in the context of adult spine procedures. These interventions have undergone evaluation in other surgical domains, and their effectiveness has been to some extent confirmed, along with the availability of clinical safety data.

If you are interested in knowing more about Prevention Of Surgical Site Infections In Adult Spine Surgery you have come to the right place!

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Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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