Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Impact of Restricted Prophylactic Antibiotic Guidelines on Surgical Site Infections in Elective Spinal Surgeries: A Nationwide Study in South Korea (114327)

Hyung-youl Park 1 , Jun-Seok Lee 1 , Yongwon Joh 1 , Young Hoon Kim 2 , Sang-Il Kim 2 , Joonghyun Ahn 3
  1. Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  2. Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  3. Orthopedic Surgery, Bucheon St.Mary's Hospital, Bucheon

Introduction: The prevention of surgical site infections (SSIs) is a critical challenge in spinal surgery, significantly impacting patient outcomes. Although prophylactic antibiotics are essential for SSI prevention, the optimal regimen and duration remain under investigation. This study evaluates the effect of limiting prophylactic antibiotics administration, as mandated by the revised Quality Assessment (QA) guidelines, on the incidence of SSIs in elective spinal surgeries in South Korea.

Methods: This retrospective study used data from health insurance claims and three waves of national QA surveys (7th to 9th) for elective spinal surgeries. In contrast to the 7th and 8th QA waves, the 9th wave limited prophylactic antibiotic use to first- or second-generation cephalosporins and restricted administration to within 24 hours post-surgery. All patients who underwent targeted spinal surgeries were included, while emergency surgeries and those with pre-existing infections were excluded. SSI rates were compared between the unrestricted group (7th and 8th waves) and the restricted group (9th wave).

Results: A total of 58,829 patients were included, with an overall postoperative infection rate of 5.79%. The incidence of SSIs was 1.54% (907 patients), while infections at non-surgical sites occurred in 4.39% (2,580 patients). The restricted group had a significantly higher incidence of SSIs compared to the unrestricted groups (2.41% vs 0.84%, p < 0.001). Despite high compliance with the prophylactic antibiotic guidelines, tertiary hospitals in the restricted group showed higher incidence of SSIs than those in the unrestricted group (odd ratio = 4.16). Multivariate analysis confirmed that antibiotic restriction was an independent risk factor for SSIs.

Discussion: The study revealed that the restrictive guidelines implemented during the 9th QA wave led to an increase in postoperative SSIs in spinal surgeries. Rather than adhering to standardized guidelines, prophylactic antibiotic strategies should be tailored to the specific demands of each spinal surgery, considering factors such as the surgical approach, the number of levels operated on, and the inherent risk of postoperative infection. Further research is needed to stratify the infection risk and determine the ideal indication for limiting the administration of prophylactic antibiotics.

 

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