title: Methods to decrease postoperative infections following posterior cervical spine surgery.
abstract: BACKGROUND
  To decrease surgical site infections, we initiated a protocol of preliminary preparation of the skin and surrounding plastic drapes with alcohol foam, and the placement of a suprafascial drain in addition to a subfascial drain in obese patients in 2004. In 2008, we additionally placed 500 mg of vancomycin powder into the wound prior to closure. The purpose of this study was to analyze the infection rates for three groups: Group C (control that received standard perioperative intravenous antibiotics alone), Group AD (alcohol foam and drain), and Group VAD (vancomycin with alcohol foam and drain).
  
  
  METHODS
  A consecutive series of 1001 all-posterior cervical spine surgical procedures performed at one institution by the senior author from 1995 to 2010 was retrospectively reviewed. These surgical procedures included foraminotomy, laminectomy, laminoplasty, arthrodesis, instrumentation, and/or osteotomies. There were 483 patients in Group C, 323 in Group AD, and 195 in Group VAD.
  
  
  RESULTS
  In Group C, nine (1.86%) of the 483 patients had an acute postoperative deep infection, in which methicillin-resistant Staphylococcus aureus was the most common pathogen. A significantly higher rate of infection was found in patients with an active smoking history (p = 0.008; odds ratio = 2.6 [95% confidence interval, 1.0 to 7.1]), rheumatoid arthritis (p = 0.005; odds ratio = 4.0 [95% confidence interval, 1.4 to 7.9]), and a body mass index of ≥30 kg/m2 (p = 0.005; odds ratio = 4.1 [95% confidence interval, 1.5 to 7.7]). Group AD (n = 323) had one infection, a significant decrease compared with Group C (p = 0.047). In Group VAD, none of the 195 patients had infections, which was also a significant decrease compared with Group C (p = 0.048).
  
  
  CONCLUSIONS
  In this study, preliminary preparation with alcohol foam and the placement of suprafascial drains for deep wounds resulted in one postoperative deep infection in 323 surgical procedures. The addition of intrawound vancomycin powder in 195 consecutive posterior cervical spine surgical procedures resulted in no infections and no adverse effects. To our knowledge, this is the first description of a technique for significantly decreasing postoperative cervical spine infections.
authors.affiliation: Department of Orthopaedic Surgery, Albert Einstein Medical Center, 5501 Old York Road/WCB 4, Philadelphia, PA 19141, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.forename: Jenny R
authors.initials: JR
authors.lastname: Pahys
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Kang
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
authors.forename: Ammar H
authors.initials: AH
authors.lastname: Hawasli
authors.forename: Fred A
authors.initials: FA
authors.lastname: Sweet
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D061605:Administration, Intravenous; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery*; D002985:Clinical Protocols; D004322:Drainage; D005260:Female; D006801:Humans; D007796:Laminectomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010027:Osteotomy; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D014640:Vancomycin