Introduction Surgical site infection (SSI) risk increases with surgical invasiveness, yet most spine surgeons do not adjust perioperative antibiotics based on surgical complexity. The purpose of this study was to evaluate the impact of tiered perioperative antibiotic coverage in spine surgery. Methods A retrospective review was conducted on patients who underwent spine surgery between 2007 and 2013 at a tertiary spine center. Trauma and deformity patients were included in the analysis. All study patients had standardized skin preparation with 3% chlorhexanol, alcohol, DuraPrep TM , and Ioban incise drape. SSIs were compared to historical data and classified as superficial, deep, or delayed deep. “Simple” cases (e.g., decompression alone, corpectomy alone, or ACDF alone) received cefazolin + gentamicin, while “complex” cases (instrumentation, front-back procedures, diabetic, obesity, trauma, etc.) received vancomycin + piperacillin/tazobactam or ceftazidime. Results Among 2162 patients, the overall SSI rate improved to 0.37%, with four superficial, three deep, and one delayed deep infection. MSSA, MRSA, and coagulase-negative staphylococci were the most common organisms. No vancomycin-resistant organisms were reported. Post-operative C. difficile was 0.19%. Discussion Tiered antibiotic prophylaxis with gram-positive and gram-negative microbial coverage resulted in low SSI rates, demonstrating the effectiveness of tailored antibiotic coverage based on case complexity. Further prospective studies are needed to validate these findings.
Warner et al. (Sat,) studied this question.