Single versus multiple dose antibiotic prophylaxis in lumbar disc surgery

Abstract

Study design: Retrospective review.

Objectives: To determine the efficacy of preoperative antibiotics alone in preventing wound infections following lumbar diskectomy.

Summary of background data: It is well documented that antibiotics given perioperatively reduce the rate of postoperative wound infections in lumbar disc surgery. At our institution, the current protocol for patients undergoing lumbar diskectomy is a single preoperative antibiotic dose. This study was conducted to compare the rate of postoperative wound infection incurred for single versus multiple perioperative antibiotic doses. It was hypothesized that no significant difference in infection rates would be identified.

Methods: This retrospective chart review compared the rates of postoperative wound infections incurred when single versus multiple perioperative antibiotic doses were given to patients having lumbar laminotomy for herniated discs. The procedures were performed between 1993 and March 1999. There were 434 patients in the multiple dose group and 201 in the single dose group. The multiple dose group received one preoperative and at least three postoperative doses of antibiotics. The single dose group received one preoperative dose of antibiotics. A postoperative infection was deemed present by either clinical diagnosis or culture results. The medical records were reviewed for 6 weeks after surgery for all patients.

Results: There were 5 out of 435 (1.15%) infections in the multiple dose group and 3 out of 201 (1.49%) in the single dose group. Statistical analysis showed no significant difference between the two study groups.

Conclusion: These results support the use of single preoperative dose of antibiotics in lumbar disc surgery. This is relevant as many lumbar diskectomy patients are candidates for early hospital discharge. At our institution, no increased risk of infection occurred for the single dose group.