A methodological systematic review on surgical site infections following spinal surgery

Part 2: Prophylactic treatments

Joost J. Van Middendorp, Albert F. Pull Ter Gunne, Michael Schuetz, Drmed Habil, David B Cohen, Allard J F Hosman, Cees J H M Van Laarhoven

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: A methodological systematic review. OBJECTIVE.: To critically appraise the validity of preventive effects attributed to prophylactic treatments for surgical site infection (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA.: As a result of a rapidly increasing number of spinal procedures, health care expenditure is expected to increase substantially in the foreseeable future. Administration of effective prophylactic treatments may prevent occurrence of SSIs and may thus result in lower costs. To date, however, no review appraising the methodological quality of studies evaluating prophylactic treatments for spinal SSIs has been published. METHODS.: Contemporary studies evaluating the preventive effect of prophylactic interventions on the rate of SSI after spinal surgery were searched through the Medline and EMBASE databases (January 2001 to December 2010). References were retrieved and bias-prone study features were abstracted individually and independently by 2 authors. RESULTS.: Eighteen eligible studies were identified, including 6 randomized controlled trials and 12 comparative cohort studies. Most often, antibiotic prophylaxis administration was investigated (n = 7). Included studies covered a wide variation of indications and surgical procedures. Except for 5 studies (28%), applied definitions of SSI outcomes were ambiguous. Although several important methodological aspects, including blinding of outcome assessors and attrition, were poorly reported in randomized controlled trials, these studies were far less susceptible to bias and confounding as observed in nonrandomized studies. None of the 12 cohort studies adjusted for confounding by matching, stratification, or multivariate regression techniques. CONCLUSION.: Given the plethora of previously hypothesized confounding risk factors for a spinal SSI, conduct of nonrandomized comparative therapeutic studies is strongly discouraged. On the other hand, methodological safeguards, including use of standardized definitions of putative confounders and outcomes, should be considered in more detail during the design phase of a randomized trial.

Original languageEnglish (US)
Pages (from-to)2034-2045
Number of pages12
JournalSpine
Volume37
Issue number24
DOIs
StatePublished - Nov 15 2012

Fingerprint

Surgical Wound Infection
Cohort Studies
Randomized Controlled Trials
Antibiotic Prophylaxis
Therapeutics
Health Expenditures
Databases
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • methodology
  • prevention
  • prophylactic treatment
  • surgical site infection
  • systematic review

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Van Middendorp, J. J., Pull Ter Gunne, A. F., Schuetz, M., Habil, D., Cohen, D. B., Hosman, A. J. F., & Van Laarhoven, C. J. H. M. (2012). A methodological systematic review on surgical site infections following spinal surgery: Part 2: Prophylactic treatments. Spine, 37(24), 2034-2045. https://doi.org/10.1097/BRS.0b013e31825f6652

A methodological systematic review on surgical site infections following spinal surgery : Part 2: Prophylactic treatments. / Van Middendorp, Joost J.; Pull Ter Gunne, Albert F.; Schuetz, Michael; Habil, Drmed; Cohen, David B; Hosman, Allard J F; Van Laarhoven, Cees J H M.

In: Spine, Vol. 37, No. 24, 15.11.2012, p. 2034-2045.

Research output: Contribution to journalArticle

Van Middendorp, JJ, Pull Ter Gunne, AF, Schuetz, M, Habil, D, Cohen, DB, Hosman, AJF & Van Laarhoven, CJHM 2012, 'A methodological systematic review on surgical site infections following spinal surgery: Part 2: Prophylactic treatments', Spine, vol. 37, no. 24, pp. 2034-2045. https://doi.org/10.1097/BRS.0b013e31825f6652
Van Middendorp, Joost J. ; Pull Ter Gunne, Albert F. ; Schuetz, Michael ; Habil, Drmed ; Cohen, David B ; Hosman, Allard J F ; Van Laarhoven, Cees J H M. / A methodological systematic review on surgical site infections following spinal surgery : Part 2: Prophylactic treatments. In: Spine. 2012 ; Vol. 37, No. 24. pp. 2034-2045.
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abstract = "STUDY DESIGN.: A methodological systematic review. OBJECTIVE.: To critically appraise the validity of preventive effects attributed to prophylactic treatments for surgical site infection (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA.: As a result of a rapidly increasing number of spinal procedures, health care expenditure is expected to increase substantially in the foreseeable future. Administration of effective prophylactic treatments may prevent occurrence of SSIs and may thus result in lower costs. To date, however, no review appraising the methodological quality of studies evaluating prophylactic treatments for spinal SSIs has been published. METHODS.: Contemporary studies evaluating the preventive effect of prophylactic interventions on the rate of SSI after spinal surgery were searched through the Medline and EMBASE databases (January 2001 to December 2010). References were retrieved and bias-prone study features were abstracted individually and independently by 2 authors. RESULTS.: Eighteen eligible studies were identified, including 6 randomized controlled trials and 12 comparative cohort studies. Most often, antibiotic prophylaxis administration was investigated (n = 7). Included studies covered a wide variation of indications and surgical procedures. Except for 5 studies (28{\%}), applied definitions of SSI outcomes were ambiguous. Although several important methodological aspects, including blinding of outcome assessors and attrition, were poorly reported in randomized controlled trials, these studies were far less susceptible to bias and confounding as observed in nonrandomized studies. None of the 12 cohort studies adjusted for confounding by matching, stratification, or multivariate regression techniques. CONCLUSION.: Given the plethora of previously hypothesized confounding risk factors for a spinal SSI, conduct of nonrandomized comparative therapeutic studies is strongly discouraged. On the other hand, methodological safeguards, including use of standardized definitions of putative confounders and outcomes, should be considered in more detail during the design phase of a randomized trial.",
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