Management of nonpurulent wound drainage following spinal surgery: is empiric oral antibiotic treatment appropriate?

Jordan S Swindle; Charles H Crawford 3rd; Luke T Byerly; Steven D Glassman; Jeffrey L Gum; Leah Y Carreon

doi:10.1016/j.spinee.2023.07.014

Management of nonpurulent wound drainage following spinal surgery: is empiric oral antibiotic treatment appropriate?

Spine J. 2023 Nov;23(11):1575-1579. doi: 10.1016/j.spinee.2023.07.014. Epub 2023 Jul 21.

Authors

Jordan S Swindle¹, Charles H Crawford 3rd², Luke T Byerly³, Steven D Glassman², Jeffrey L Gum², Leah Y Carreon⁴

Affiliations

¹ University of Louisville School of Medicine, 500 South Preston St, Instructional Building, Room 305, Louisville, KY, 40202 USA.
² Department of Orthopedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St, 1st Floor ACB, Louisville, KY, 40202 USA; Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY, 40202 USA.
³ Department of Orthopedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St, 1st Floor ACB, Louisville, KY, 40202 USA.
⁴ Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY, 40202 USA. Electronic address: leathermanspineresearch@gmail.com.

PMID: 37482252
DOI: 10.1016/j.spinee.2023.07.014

Abstract

Background context: Postoperative incisional concerns including nonpurulent drainage are relatively common following spine surgery. Evidence-based management protocols are lacking.

Purpose: The purpose of this study is to determine if prescribing empiric oral antibiotics for nonpurulent wound drainage is beneficial for the prevention of chronic infection or reoperation.

Study design: Retrospective chart review.

Patient sample: Patients calling the office with postsurgical wound concerns.

Outcome measures: Not applicable.

Methods: In a large, multisurgeon, spine surgery practice, a review of the communications log showed that 298 patients called or messaged the office with a concern regarding postoperative nonpurulent wound drainage. Patients were prescribed empiric oral antibiotics based on surgeon preference. Patients who received empiric oral antibiotic treatment (AbxTx) were propensity matched to patients who did not (No AbxTx) based on sex, age, BMI, ASA grade, smoking status, prior spine surgery, anatomic location, and number of surgical levels. The number of patients requiring surgical intervention (debridement) and/or developing a chronic infection was determined.

Results: Oral antibiotics were prescribed for 112 of the 298 (38%) patients with reports of nonpurulent drainage. Demographic and surgical characteristics of the two matched cohorts were similar. Although there were more patients in the AbxTx group who required surgical intervention (n=17, 17%) compared to the No AbxTx group (n=9, 9%), this difference was not statistically significant (p=.139). The intra-operative culture results showed no growth in 94% (16/17) of the AbxTx group vs 67% (6/9) of the No AbxTx group (p=.103). One patient in each group required a return to the operating room within the year after the initial surgical debridement for management of chronic infection.

Conclusion: In this large series (n=298) of patients with nonpurulent wound drainage following spine surgery, 87% resolved without the need for surgical intervention. Empiric oral antibiotics did not reduce the need for surgical intervention or the development of a chronic infection. In addition to the added cost, potential adverse reactions, development of resistant organisms, and inaccurate labeling of surgical site infection; empiric oral antibiotics may lead to a negative intraoperative culture for those requiring surgical intervention impacting the ability to prescribe a specific antibiotic regimen.

Keywords: Empiric antibiotics; Incision and drainage; Propensity-matched cohort; Spine surgery; Surgical site infection.