Prospective prophylactic antibiotics regimen in scheduled spine surgery, or the PPARiSSS cohort

OBJECTIVE: To possibly define a minimum expected deep surgical site infection rate in elective lumbar reconstructive surgery. METHODS: The senior author provides an extended postoperative antibiotics prophylaxis to all surgical cases. Combined with a standard program of wound care and drainage, the rate of deep surgical site infection requiring reoperation has been negligible. A cohort of 1000 qualifying cases had surgery over a 13-year period. Four independent observers were tasked with reviewing hospital records of the index operations and all patient contact going forward, specifically focused on evidence of postoperative infection requiring reoperation. We also scanned for the potential emergence of AROs colonization in the treated patients. The data produced were analyzed for inter-rater reproducibility using the Fleiss' kappa statistic. RESULTS: The observed frequency of infections at 0.3 % was a small fraction of that predicted by meta-analysis in the literature. ARO frequency was within the expected range reported by Public Health Canada. CONCLUSIONS: These data may be sufficient to justify prospective investigations going forward.