Assessment of surgical site infection after different intraoperative irrigation strategies in single-segment transforaminal lumbar interbody fusion

English Keywords:Lumbar fusion  Intraoperative irrigation  Surgical site infection

English Abstract:

  【Abstract】 Objectives: To evaluate three strategies of intraoperative irrigation and their effects on control of postoperative surgical site infections. Methods: 139 consecutive patients in our ward undertaking single segment transforaminal lumbar interbody fusion(TLIF) were collected, and all the cases were categorized into three groups according to different methods of irrigation: group A, simple irrigation before closure; group B, continuous intraoperative irrigation with normal saline; group C, continuous intra-operative irrigation with antibiotic solutions. The Centre for Disease Control and Prevention(CDC) definition of surgical site infection(SSI) was used. All patients were followed up for 1 year. For data analysis, ANOVA test was used to analyze normally distributed variables and K-W test for abnormal distribution. K-W test was also used to analyze enumeration and ranked data. Results: Significant differences were found amongst parameters between group B and A, and group C and A, such as blood loss (185ml vs 240ml, P=0.001; 185ml vs 240ml, P=0.008), postoperative drainage for the first 24 hours (90ml vs 160ml, P=0.036; 100ml vs 160ml, P=0.029) and postoperative hospital stay(7 vs 10.5, P<0.001; 6 vs 10.5, P=0.001). The increase in white blood cell count was found to be significantly different in group B and C compared to group A (66.42±8.7% vs 83.06±9.60%,P=0.028; 65.91±11.2% vs 83.06±9.60%,P=0.032). Groups B and C showed a more significant decrease in VAS score compared to group A. 3 cases in group A (6.12%), 1 case (2.04%) in group B and no case in group C showed positive evidence of SSI. All the infected cases were cured after irrigation and antibiotic treatment. SSI rates were found to be lower in group B and C compared to group A, but no significant differences between any two of the three groups were found. Pre and postoperative changes of CRP, CK and monocyte HLA-DR expressions in group B and C were less than those of group A at 24 hours after surgery, but there were no significant differences. Conclusions: Continuous lavage with normal saline or antibiotic solution can significantly decrease the amount of intraoperative blood loss and postoperative drainage as well as shorten the postoperative hospital stay. Thus, continuous irrigation alone with use of electrotome may have a positive effect in controlling the SSI risk.