Impact of restricted prophylactic antibiotic guidelines on surgical site infection rates following spinal surgery in Korea: a nationwide cohort analysis.

Abstract

To evaluate the impact of restrictive prophylactic antibiotic guidelines on the incidence of surgical site infections (SSIs) following elective spinal surgery using nationwide quality assessment data from South Korea. Nationwide retrospective cohort study comparing SSI rates between unrestricted (seventh and eighth quality assessment waves) and restricted (ninth wave) prophylactic antibiotic guideline periods using multivariable logistic regression. All healthcare institutions performing elective spinal surgery and participating in the Health Insurance Review and Assessment Service (HIRA) quality assessment programme in South Korea. A total of 58 829 adult patients who underwent elective spinal surgery during the seventh (2015), eighth (2017) and ninth (2020) HIRA quality assessment waves were included. None. The primary outcome was the incidence of post-operative SSIs. Secondary outcomes included non-surgical site infections and factors associated with SSI occurrence. The overall post-operative infection rate was 5.79%. The incidence of SSIs was significantly higher in the restricted antibiotic group than in the unrestricted group (2.41% vs 0.84%). In multivariable logistic regression analysis, restrictive prophylactic antibiotic use was independently associated with an increased risk of SSIs (adjusted OR, 2.48; 95% CI 2.13 to 2.89; p<0.001). When stratified by hospital type, patients treated in tertiary hospitals had the highest SSI risk (adjusted OR, 4.47; 95% CI 3.65 to 5.47), followed by those treated in general hospitals (adjusted OR, 3.03; 95% CI 2.55 to 3.60) (all p<0.001). Non-surgical site infections were also more frequent in the restricted group. Restrictive prophylactic antibiotic guidelines were associated with a higher incidence of post-operative infections following elective spinal surgery. These findings suggest that prophylactic antibiotic strategies may need to consider patient risk profiles and surgical complexity rather than applying a uniform approach.