Medical Student USF Morsani College of Medicine, United States
Introduction: Adult spinal deformity (ASD) is usually treated with long segment spinal fusions to re-align the spine to a more physiologic alignment. These long segment fusions often involve the majority of a patient’s torso down to the top of the intergluteal cleft and patients remain recumbent on their incisions for long periods of time. As such, infection rates for these surgeries are higher than most.
Methods: We conducted a retrospective review of all degenerative long construct surgeries at our tertiary care center from 2016-2021. Long construct cases were defined by fusions with upper instrumented vertebra of L2 or higher and lower instrumented vertebra of S1 or the pelvis. During this period we developed a protocol to prevent wound infection: intense routine sterility education in the operating room; immediately before closure, soak the open wound and overlying ioban/nearby drapes in iodine solution for three minutes, then soak the wound in 0.5% hydrogen peroxide for three minutes, followed by pulse lavage of 2 liters of antibiotic impregnated saline; after closure, wash the wound with alcohol; administer vancomycin with cefepime prophylaxis until surgical drains are removed; remove postoperative Silverlon dressing on postoperative day 5, re-apply iodine solution to the wound, re-dress wound with Silverlon; give instructions to only have patients wear thoracolumbar braces when ambulating immediately postoperatively.
Results: Over the five years under study, 216 patients were identified. Of these, 9 (4.2%) had a postoperative infection requiring surgical revision. Average age was 62 years in both the infection and non-infection group. 60% of patients without infection were males versus 78% of those with infection (p=0.488). Body mass index (BMI) was higher in those who developed infection (32.9+4.2kg/m2 versus 29.0+0.78kg/m2, p=0.045). Most inferior instrumentation (S1 pedicle screws, iliac screws, or S2-alar-iliac screws) was not associated with infection (p=0.399). Patients with infection were more likely to have been (or required) disposition to rehabilitation (50% of those with infection versus 25% of those without infection; p=0.031).
Conclusion : Our cohort of ASD patients were found to have low rates of wound infection compared to previously published rates, likely due to our protocol as detailed above.
