Risk of Surgical Site Infection in Posterior Spine Surgery Using Different Closing Techniques: A Retrospective Study of Two Neurosurgical Centers.

Objectives

To determine whether a closed dressing protocol reduces the surgical site infections (SSI) rate compared to conventional closing techniques.

Methods

Patients who underwent lumbar spine surgery at two neurosurgical centers were retrospectively included from June 2015 to December 2019. Data on patients, general risk factors, and surgical risk factors for SSI were collected. Patients were subdivided into two groups: a Closed Protocol where the Dermabond® ± Prineo® dressing system was used, and a Conventional Protocol, namely sutures or staples. Statistical analysis was undertaken to compare the infection rates among the different closure techniques.

Results

Altogether, 672 patients were included. In the whole cohort, 157 (23.36%) underwent skin closure with staples, 122 (18.15%) with sutures, 98 (14.58%) with intracutaneous sutures, 78 (11.61%) with Dermabond®, and 217 (32.29%) with Demabond® + Prineo®. The overall infection rate was 2.23% (n = 15). Skin suture had the highest infection rate (4.10%), while the lowest was Dermabond® (1.28%) and Dermabond® + Prineo® (1.4%), though the difference was not significant. Risk factors for SSI included higher BMI (29.46 kg/m2 vs. 26.96 kg/m2, p = 0.044), other sites infection (20.00% vs. 2.38%, p = 0.004), and a higher national nosocomial infections surveillance score (p = 0.003).

Conclusions

This study showed that a closed protocol with the use of adhesive dressing with or without mesh had a slight tendency to lower infection rates compared to conventional protocol with sutures or staples, although no statistically significant difference was found between the closure techniques. Larger randomized studies are needed to investigate this potential benefit avoiding selection bias.