Local Antibiotics in posterior lumbar fusion procedures for
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Surgical site infections (SSIs) are medically devastating and financially costly complications after posterior spinal fusion (PSF) for neuromuscular scoliosis (NMS). Many strategies exist to reduce their occurrence. The efficacy of intraoperative antibiotics in the wound or bone graft is gaining in popularity.

A Study was conducted to assess the potential utility of intraoperative local antibiotics in patients with NMS undergoing PSF. Perioperative adverse outcome variables assessed included the occurrence of SSI, renal complications, and adverse hospital metrics.

Patient demographic factors, comorbidities, and the use of intraoperative antibiotics in the wound were recorded (a specifically assessed variable in the dataset). The association between the use of intraoperative antibiotics and the occurrence of adverse outcomes/infection was assessed for the entire study population and higher risk sub-populations.

Results:
In total, 1990 patients met the inclusion criteria, of which 87% received local antibiotics.
--Higher risk patients were more likely to receive local antibiotics in the wound as part of their procedure. When controlling for potentially confounding factors, the use of local antibiotics was not statistically significantly associated with any of the studied adverse outcomes for the overall study population.
--Subgroup analysis of higher risk patient populations (more than 13 levels fused, osteotomy performed, prior deformity surgery, nonasthma lung condition) revealed a significantly decreased risk of SSI in patients undergoing more than 13 level fusions (relative risk: 0.48).

Conclusively, with no increased overall risks and reduced SSIs in higher risk NMS patients undergoing PSF, the use of intrawound antibiotics appears to be supported by this dataset.

Source: https://www.thespinejournalonline.com/article/S1529-9430(20)31253-5/fulltext
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