Invasive dental procedures as risk factors for postoperative spinal infection and the effect of antibiotic prophylaxis — The International Society for the Study of the Lumbar Spine
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  2. Special Poster Session 2G. EPIDEMIOLOGY AND RISKS
  3. Invasive dental procedures as risk factors for postoperative spinal infection and the effect of antibiotic prophylaxis

Invasive dental procedures as risk factors for postoperative spinal infection and the effect of antibiotic prophylaxis (#130)

Soo-Bin Lee 1 , Sahyun Sung 2 , Ji-Won Kwon 3 , Seong-Hwan Moon 3 , Byung Ho Lee 3
  1. Department of Orthopedic Surgery, Kwandong university college of medicine, Seo-gu, Incheon, Korea, Republic of
  2. Department of Orthopedic Surgery, Ewha Womans University College of Medicine, Gangseo-gu, SEOUL, Korea, Republic of
  3. Department of Orthopedic Surgery, Yonsei university college of medicine, Seodaemun-gu, Seoul, Korea, Republic of

 

INTRODUCTION

Since invasive dental procedure causes temporary bacteremia, antibiotic prophylaxis is recommended in patients with prosthetic cardiac valves who are at high risk of developing endocarditis. However, there are few studies on the risk of postoperative spinal infection following dental procedure and the effectiveness of antibiotic prophylaxis. Some experts recommended avoiding dental procedure until 3 months after spinal surgery, and administering prophylactic antibiotics if necessary. However, these recommendations have not been proven in clinical studies. The purpose of this study is to identify invasive dental procedure as risk factor of postoperative spinal infection and to evaluate the effect of antibiotic prophylaxis.


METHODS

We analyzed 229,235 patients over 50 years of age who underwent spinal fusion or fixation from 2010 to 2017 using the Health Insurance Review and Assessment Service (HIRA) data. The incidence of spinal infection with 2 years after surgery was identified. Invasive dental procedure and antibiotic prophylaxis as risk factors for postoperative spinal infection during this period were also analyzed. Time dependent cox regression analysis was performed to identify risk factors for postoperative spinal infection.

 

RESULTS

A total of 15,346 patients (6.7%) were diagnosed with postoperative spinal infection. Of the patients who underwent spinal surgery, 70,650 (30.82%) received invasive dental procedure within 2 years, of which 18,267 (25.9%) patients received antibiotic prophylaxis. It was confirmed that the old age, male, and high Charlson Comorbidity Index Score were risk factors for postoperative spinal infection. The risk of postoperative spinal infection is not increased following dental procedure (adjust HR : 0.892, P=0.0006) and is not affected by antibiotic prophylaxis. (adjust HR: 1.037, P=0.5243)

 

DISCUSSION

Invasive dental procedures in patients who underwent spinal surgery with instrumentation are not risk factors for postoperative infection. It was also confirmed that early dental treatment was not associated with the risk of postoperative infection. In addition, antibiotic prophylaxis following dental procedures was not effective in preventing spinal infection. Therefore, we believe that patients undergoing spinal surgery with instrumentation should not avoid dental treatment after surgery, and prophylactic antibiotics may not be necessary.

  1. Wilson W, Taubert KA, Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736-54.
  2. Kao FC, Hsu YC, Chen WH, Lin JN, Lo YY, Tu YK. Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty. Infect Control Hosp Epidemiol 2017;38:154-61.
  3. Martin P, Hundal R, Matulich K, Porta M, Patel R, Aleem I. Is dental prophylaxis required following spinal fusion?-a systematic review and call for evidence. J Spine Surg 2020;6:13-7.
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