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Long-term Intravenous Administration of Antibiotics for Lumbar Spinal Surgery Prolongs the Duration of Hospital Stay and Time to Normalize Body Temperature After Surgery

Ohtori, Seiji, MD, PhD; Inoue, Gen, MD, PhD; Koshi, Takana, MD, PhD; Yamashita, Masaomi, MD; Yamauchi, Kazuyo, MD; Suzuki, Munetaka, MD; Orita, Sumihisa, MD; Eguchi, Yawara, MD, PhD; Ochiai, Nobuyasu, MD, PhD; Kishida, Shunji, MD, PhD; Takaso, Masashi, MD, PhD; Takahashi, Kazuhisa, MD, PhD

doi: 10.1097/BRS.0b013e3181895939
Surgery
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Study Design. Comparative study of differing durations of antibiotics for spinal surgery.

Objective. To compare rate of infection, duration of hospital stay, days until normal body temperature, and a panel of blood tests after surgery between long-term and short-term administration of antibiotics for spinal surgery using instrumentation.

Summary of Background Data. Recent studies have reported that long-term administration of intravenous antibiotics is not necessary to avoid superficial and deep infections. We therefore changed the duration of administration from 9 to 2 days in our lumbar surgery patients.

Methods. We examined 135 patients (average age, 64.9 years) who underwent lumbar spinal surgery to insert a pedicle screw system to treat spinal canal stenosis. We administered 2 g of cefotiam daily to 60 patients for 9 days after surgery and to 75 patients for 2 days after surgery. Surgical time, loss of blood, rate of infection, duration of hospital stay, days until normal body temperature, and data from blood analysis (white blood cell count, and C-reactive protein [CRP] level) were statistically compared between the 2 groups.

Results. No significant differences in intraoperative measures of surgical invasion were observed between the 2 groups (surgical time, 209 vs. 220 minutes; blood loss, 530 vs. 576 mL; blood transfusion, 344 vs. 380 mL for the long-term and short-term groups, respectively). No acute infections occurred in either group. However, the duration of hospital stay (20.7 days), time until normal body temperature (5.1 days), and CRP level (2.23 mg/dL) at day 7 after surgery were significantly less in the short-term group than those in the long-term group (27.9 days, 6.8 days, and 3.13 mg/dL, respectively; P < 0.05).

Discussion. These results indicate that short-term intravenous administration of antibiotics did not elevate the infection rate after spinal surgery using instrumentation. However, long-term administration of antibiotics prolonged the duration of hospital stay, inhibited normalization of body temperature, and elevated CRP levels. Long-term administration of antibiotics may suppress normal, beneficial bacteria, thereby having an adverse effect on patient recovery.

We compared rate of infection, duration of hospital stay, days until normal body temperature, and a panel of blood tests after surgery between long-term and short-term administration of antibiotics for spinal surgery, using instrumentation. A short duration of intravenous administration of antibiotics did not elevate infection rates after spinal surgery, using instrumentation. However, long-term administration of antibiotics prolonged the duration of hospital stay, inhibited normalization of body temperature, and elevated C-reactive protein levels. Long-term administration of antibiotics may suppress normal, beneficial bacteria, with adverse consequences for patients.

From the Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

Acknowledgment date: March 27, 2008. Acceptance date: July 15, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Seiji Ohtori, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8–1 Inohana, Chuo-ku, Chiba 260-8670, Japan; E-mail: sohtori@faculty.chiba-u.jp

© 2008 Lippincott Williams & Wilkins, Inc.