• Ariane Lewis, Jessica Lin, Herbert James, Anne Clara Krok, Nicole Zeoli, Janine Healy, Tyler Lewis, and Donato Pacione.
• a Department of Neurology , NYU Langone Medical Center , New York , NY , USA.
• Br J Neurosurg. 2018 Apr 1; 32 (2): 177-181.

IntroductionPostoperative antibiotics (PA) are often administered to patients after instrumented spinal surgery until all drains are removed to prevent surgical site infections (SSI). This practice is discouraged by numerous medical society guidelines, so our institutional Neurosurgery Quality Improvement Committee decided to discontinue use of PA for this population.MethodsWe retrospectively reviewed data for patients who had instrumented spinal surgery at our institution for seven months before and after this policy change and compared the frequency of SSI and development of antibiotic related complications in patients who received PA to those who did not (non-PA).ResultsWe identified 188 PA patients and 158 non-PA patients. Discontinuation of PA did not result in an increase in frequency of SSI (2% of PA patients vs. 0.6% of non-PA patients, p = .4). Growth of resistant bacteria was not significantly reduced in the non-PA period in comparison to the PA period (2% in the PA period and 1% in the non-PA period). The cost of antibiotics for PA patients was $5,499.62, whereas the cost of antibiotics for the non-PA patients was $0. On a per patient basis, the cost associated with antibiotics and resistant infections was significantly greater for patients who received PA than for those who did not (median of $26.32 with IQR $9.87-$46.06 vs. median of $0 with IQR $0-$0; p < .0001).ConclusionAfter discontinuing PA for patients who had instrumented spinal procedures, we did not observe an increase in the frequency of SSI. We did, however, note that there was a non-significant decrease in the frequency of growth of resistant organisms. These findings suggest that patients in this population do not need PA, and complications can be reduced if PA are withheld.

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