Background: Discontinuation of prophylactic antibiotics within 24 hours after surgery is recommended in multiple guidelines. The objective of this study was to determine the prevalence and patterns of prophylactic post-discharge antibiotic use after spinal fusion in a geographically representative, privately-insured population.
Methods: We established a cohort of patients (pts) aged 1064 years undergoing inpatient or ambulatory surgery spinal fusion between 1/1/20106/30/2015 using the Truven Health MarketScan Database. Antibiotics were identified from outpatient drug claims ≤5 days post-discharge; comorbidities were assessed ≤1 year before surgery. Pts with infection during the surgical admission or ≤ 30 days prior were excluded. Univariate logistic regression and chi-square tests were used to compare antibiotic utilization for operative factors, demographics and comorbidities.
Results: The analysis included 174,202 fusion procedures, with 51.5% of surgeries involving the cervical spine, 81.3% involving 1-2 vertebral levels, and 53.05% using an anterior approach. The median pt age was 52 years and 55.3% were female. Post-discharge prophylactic antibiotics were used in 13,611 (7.8%) of surgeries, with cephalexin (39.2%) and levofloxacin (10.5%) the most commonly prescribed. Post-discharge antibiotic use decreased significantly from 2010-2015 (8.3% of procedures in 2010 vs. 7.7% in 2015; p <0.001; Cochran-Armitage test), was higher in rural areas (8.8% of rural vs. 7.6% of urban/suburban pts; p <0.001), and differed by US region (8.5% South, 8.1% West, 6.9% North Central, 6.6% Northeast; p <0.001). Pts prescribed prophylactic post-discharge antibiotics had more comorbidities including obesity, diabetes, pulmonary disease, hypertension, and psychoses (all p <0.001). Post-discharge antibiotic use varied by surgical approach (9.6% anterior/posterior, 9.2% posterior only, 6.8% anterior only; p <0.001) and spine region (9.4% lumbar, 6.7% cervical, 6.7% multiple regions, 6.1% thoracic; p <0.001), and was more common when >2 vertebral levels were involved (p <0.001).
Conclusion: Post-discharge antibiotic prophylaxis following spinal fusion surgery was associated with geographic, operative and patient factors.
D. K. Warren,
K. B. Nickel, None
V. Fraser, None
M. A. Olsen, None