INTRODUCTION

Perioperative prophylactic antibiotic (PPA) use in spine surgery is known to reduce the rate of surgical site infections (SSI) and it has been routine perioperative management. The rate of SSIs ranges from 0.7% to 10% and they are directly linked to post-operative health-related quality of life (HRQOL) and economic burden to patients. It is also one of the common cause of readmission within thirty-days and the hospitalization cost was nearly 2 to 3 times greater than that of patients without complications. Therefore PPA usage has always been of great interest to spine surgeons.

METHODS

This is a narrative review of PPA usage during instrumented lumbar spinal surgeries in adult patients (age 19 or more) from year 2010 to 2018, using South Korean population-based cohort data from Korean Nation Health Insurance (KNHI) and Korean Health Insurance Review and Assessment Service (HIRA). All patients assigned with the code for instrumented lumbar surgery were included. Patients with two or more instrumented lumbar surgeries assigned on a single day were counted as one. All codes for intravenous antibiotics that were prescribed on the day of operation were counted as one. Each prescriptions were reviewed for underlying disease, such as diabetes mellitus and renal disease, which was diagnosed within 1 year prior to the operation.

RESULTS

A total of 294,354 instrumented lumbar surgery were performed in 278,815 patients from 2010 to 2018, out of which 292,598 (99.40%) received PPA. A constant increase in first generation cephalosporin prescriptions was observed from 48.99% in 2010 to 66.52% in 2018. Second most frequent PPA was second generation cephalosporin. From 2010 to 2016, it was prescribed on average of 28.15% of all instrumented lumbar surgeries without major increasing or decreasing trend. However, from the year 2016 the prescribing trend abruptly decreased to 20.30% by 2018. The use of third generation cephalosporin and other miscellaneous antibiotics showed clearly decreasing trend from 2010 to 2014. Vancomycin prescriptions increased by almost 4-folds during the studied period. In renal disease patients, less first generation cephaloporin was prescribed, whereas prescription for third generation increased.

DISCUSSION

Appropriate use of PPA has clearly decreased the incidence of SSI in spine surgeries. In early days, the use of PPA were mostly based on expert’s opinion, but series of guidelines have been published with cumulative evidences on PPA use in spine surgeries since the late 90s’. Furthermore, surveillance systems for appropriate use of antibiotics were developed and conducted among medical institutes nationwide. In concordance to guidelines and action plans for surveillance system, PPA regimen is becoming more uniform in South Korea.