• Evgenii Belykh, Alessandro Carotenuto, Andrey A Kalinin, Serik K Akshulakov, Talgat Kerimbayev, Vladislav E Borisov, Marat A Aliyev, Peter Nakaji, Mark C Preul, and Vadim A Byvaltsev.
• Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
• World Neurosurg. 2019 Mar 1; 123: 390-401.e2.

ObjectiveTo analyze the effects of a surgical protocol for infections, nonhealing wound prophylaxis, and analgesia among patients who underwent posterior spinal fusion at a single tertiary-care neurosurgical center.MethodsThis prospective study was conducted in the neurosurgery department of a tertiary-care neurosurgical center and compared a control group of patients who had posterior spinal fusion within 3 months before implementation of a surgical protocol with a study group of patients enrolled within 1 year after protocol implementation. The protocol included a surgical safety checklist, control of modifiable risks associated with surgical site infection, administration of intrawound vancomycin and local analgesia, and standard closure. Postoperative pain, demand for analgesics, and postoperative surgical site infections were assessed among patients before and after the introduction of the protocol.ResultsThe control group (n = 35; 30 women; median age, 40 years [interquartile range, 31-54 years]) experienced a higher-than-predicted rate of minor surgical infections and nonhealing wounds (12 patients; 34%). In the study group (n = 113; 74 women; median age, 45 years [interquartile range, 37-54 years]), 11 patients (10%) had minor surgical infections and nonhealing wounds. Introduction of the protocol was associated with a 24% absolute risk reduction for minor surgical site infection and a significant decrease in pain on postoperative days 1 and 2 (P < 0.01 for both). Interpersonal communication improved among specialists involved in patient management.ConclusionsThe protocol was effective in reducing postoperative pain and the rate of surgical site infection among patients with posterior spinal surgeries.Copyright © 2018 Elsevier Inc. All rights reserved.

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