Department of Neurosurgery, The Alfred Hospital, Level 1, Old Baker Building, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; National Trauma Research Institute, Melbourne, Victoria, Australia.
Department of Neurosurgery, The Alfred Hospital, Level 1, Old Baker Building, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
Spine J. 2020 Mar;20(3):435-447. doi: 10.1016/j.spinee.2019.09.013. Epub 2019 Sep 23.
There are three phases in prophylaxis of surgical site infections (SSI): preoperative, intraoperative and postoperative. There is lack of consensus and paucity of evidence with SSI prophylaxis in the postoperative period.
To systematically evaluate the literature, and provide evidence-based summaries on postoperative measures for SSI prophylaxis in spine surgery.
Systematic review, meta-analysis, evidence synthesis.
A systematic review conforming to PRIMSA guidelines was performed utilizing PubMed (MEDLINE), EMBASE, and the Cochrane Database from inception to January 2019. The GRADE approach was used for quality appraisal and synthesis of evidence. Six postoperative care domains with associated key questions were identified. Included studies were extracted into evidence tables, data synthesized quantitatively and qualitatively, and evidence appraised per GRADE approach.
Forty-one studies (nine RCT, 32 cohort studies) were included. In the setting of preincisional antimicrobial prophylaxis (AMP) administration, use of postoperative AMP for SSI reduction has not been found to reduce rate of SSI in lumbosacral spine surgery. Prolonged administration of AMP for more than 48 hours postoperatively does not seem to reduce the rate of SSI in decompression-only or lumbar spine fusion surgery. Utilization of wound drainage systems in lumbosacral spine and adolescent idiopathic scoliosis corrective surgery does not seem to alter the overall rate of SSI in spine surgery. Concomitant administration of AMP in the presence of a wound drain does not seem to reduce the overall rate of SSI, deep SSI, or superficial SSI in thoracolumbar fusion performed for degenerative and deformity spine pathologies, and in adolescent idiopathic scoliosis corrective surgery. Enhanced-recovery after surgery clinical pathways and infection-specific protocols do not seem to reduce rate of SSI in spine surgery. Insufficient evidence exists for other types of spine surgery not mentioned above, and also for non-AMP pharmacological measures, dressing type and duration, suture and staple management, and postoperative nutrition for SSI prophylaxis in spine surgery.
Despite the postoperative period being key in SSI prophylaxis, the literature is sparse and without consensus on optimum postoperative care for SSI prevention in spine surgery. The current best evidence is presented with its limitations. High quality studies addressing high risk cohorts such as the elderly, obese, and diabetic populations, and for traumatic and oncological indications are urgently required.
手术部位感染（SSI）的预防分为三个阶段：术前、术中和术后。在术后预防 SSI 方面，目前尚无共识，且证据不足。
系统评估文献，为脊柱外科手术 SSI 预防的术后措施提供循证总结。
系统回顾、荟萃分析、证据综合。
根据 PRISMA 指南，检索 PubMed（MEDLINE）、EMBASE 和 Cochrane 数据库，时间从建库至 2019 年 1 月。采用 GRADE 方法评估质量并综合证据。确定了六个与关键问题相关的术后护理领域。将纳入的研究提取到证据表中，进行定量和定性数据综合，并根据 GRADE 方法评估证据。
共纳入 41 项研究（9 项 RCT，32 项队列研究）。在术前预防性使用抗生素（AMP）的情况下，术后使用 AMP 预防 SSI 并不能降低腰骶部脊柱手术的 SSI 发生率。术后 AMP 持续使用超过 48 小时似乎并不能降低单纯减压或腰椎融合手术的 SSI 发生率。在腰骶部脊柱和青少年特发性脊柱侧凸矫正手术中使用伤口引流系统似乎并不能改变脊柱手术的总体 SSI 发生率。在存在伤口引流管的情况下同时使用 AMP 似乎并不能降低退行性和畸形脊柱疾病的胸腰椎融合术和青少年特发性脊柱侧凸矫正术的总体 SSI 发生率、深部 SSI 发生率或浅表 SSI 发生率。增强术后康复临床路径和感染特异性方案似乎并不能降低脊柱手术的 SSI 发生率。对于上述未提及的其他类型的脊柱手术，以及非 AMP 药物治疗、敷料类型和持续时间、缝合和订书钉管理以及术后营养等预防 SSI 的措施，目前尚无足够的证据。
尽管术后阶段是 SSI 预防的关键，但文献稀少，且在脊柱外科手术中术后护理预防 SSI 方面尚无共识。目前提出了最佳的现有证据，但存在局限性。迫切需要高质量的研究来针对老年人、肥胖人群和糖尿病患者等高危人群，以及创伤和肿瘤等特定适应症开展研究。
