Implementing a Multidisciplinary Clinical Pathway Can Reduce the Deep Surgical Site Infection Rate After Posterior Spinal Fusion in High-Risk Patients.

Abstract

DESIGN:

Retrospective comparative study.

OBJECTIVE:

The purpose of this study is to measure SSI outcomes before and after implementation of our center's multidisciplinary clinical pathway protocol for high-risk spinal surgery.

BACKGROUND:

Surgical site infections (SSIs) after spinal fusion harm patients and are associated with significant health care costs. Given the high rate of SSI in neuromuscular populations, there is a rationale to develop infection prevention strategies.

METHODS:

An institutional clinical pathway was created in 2012 and based on nationally published Best Practice Guidelines as well as hospital practices with a goal of reducing the rate of deep SSI in high-risk patients. Patient and procedure characteristics were compared prior to (2008-2011) and after (2012-2016) implementation of the pathway. Logistic regression using penalized maximum likelihood was used to assess differences in rate of infection before and after implementation.

RESULTS:

Cohorts of 132 and 115 high-risk patients were analyzed before and after pathway implementation. Rate of deep infections decreased from 8% to 1% of patients (p = .005). Preoperative antibiotics were dosed within 1 hour in 90% of the postpathway cohort. Redosing was successful in 94% of patients for first redose and 79% for second redose. Betadine irrigation was used in 76% of cases and vancomycin administered in 86%. Multivariable analysis determined that instances of compliant antibiotics dosing had 63% lower odds of infection compared with instances of noncompliance (p = .04).

CONCLUSIONS:

Implementation of a multidisciplinary pathway aimed to reduce infection in patients at high risk for SSI after spinal fusion led to a significant reduction in deep SSI rate. It is impossible to attribute the drop in the deep SSI rate to any one factor. Our results demonstrate that adherence to a protocol using multiple strategies to reduce infection results in a lower SSI rate, lower care costs, and improved patient-related outcomes.

LEVEL OF EVIDENCE:

Level III.

• Authors: Michael Glotzbecker, Michael Troy, Patricia Miller, Jay Berry, Lara Cohen, Alexandra Gryzwna, Mary Ellen McCann, M Timothy Hresko, Susan Goobie, John Emans, Robert Brustowitz, Brian Snyder, Daniel Hedequist
• Journal: Spine deformity (Spine Deform) Vol. 7 Issue 1 Pg. 33-39 (01 2019) ISSN: 2212-1358 [Electronic] England
• PMID: 30587318 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2018 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Vancomycin
• Povidone-Iodine

Topics

• Adolescent
• Antibiotic Prophylaxis (methods)
• Critical Pathways
• Female
• Humans
• Logistic Models
• Male
• Patient Care Team
• Povidone-Iodine (therapeutic use)
• Retrospective Studies
• Risk Factors
• Spinal Fusion (adverse effects)
• Surgical Wound Infection (prevention & control)
• Vancomycin (therapeutic use)