- Department of Neurosurgery, University of California, Los Angeles, USA
- Department of Orthopedic Surgery, University of California, Los Angeles, USA
Daniel C. Lu
Department of Neurosurgery, University of California, Los Angeles, USA
Department of Orthopedic Surgery, University of California, Los Angeles, USA
DOI:10.4103/2152-7806.111434Copyright: © 2013 Li CH This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Li CH, Yew AY, Kimball JA, McBride DQ, Wang JC, Lu DC. Comparison of operating field sterility in open versus minimally invasive microdiscectomies of the lumbar spine. Surg Neurol Int 06-May-2013;4:
How to cite this URL: Li CH, Yew AY, Kimball JA, McBride DQ, Wang JC, Lu DC. Comparison of operating field sterility in open versus minimally invasive microdiscectomies of the lumbar spine. Surg Neurol Int 06-May-2013;4:. Available from: http://sni.wpengine.com/surgicalint_articles/comparison-of-operating-field-sterility-in-open-versus-minimally-invasive-microdiscectomies-of-the-lumbar-spine/
Background:Postoperative wound infection is a preventable risk that can lead to significant adverse outcomes and increased cost of care. Minimally invasive surgeries (MIS) have been found to have lower rates of postoperative infection compared with the traditional approach. To assess if the reported difference is related to intraoperative contamination or to other factors, we assessed the surgical field for sterility.
Methods:We compared 10 MIS versus 10 traditional microdiscectomies. Swabs of the operating field were obtained before and after the procedure from multiple sites in the operating room. Positive and negative controls were taken of the skin immediately before and after preparation of the incision site. All swabs were plated out on Columbia blood agar plates and grown for 48 hours. Colony counting was performed to determine growth.
Results:There was no statistically significant difference in the colony counts of swab sites in traditional microdiscectomies compared with MIS microdiscectomies. There was no significant contamination of the operating field using either approach.
Conclusions:In this prospective study, we found that there was no significant difference in bacterial counts in swabs of operative sites in either traditional or MIS microdiscectomies, suggesting that the decreased rate of postoperative infection in the reported literature for MIS cases may be related to other factors, such as patient selection and/or postoperative care.
Keywords: Infection, lumbar surgery, microdiscectomy, sterility
Lumbar microdiscectomies are one of the most common spinal surgeries performed for back and leg pain in the United States.[
One of the possible complications following microdiscectomies is postoperative wound infection. Patients undergoing spinal procedures may suffer from postoperative infections due to the long operative times, instrumentation, and the amount of tissue trauma associated with lumbar spinal surgeries.[
It has been suggested that there may be less postoperative infections following MIS surgeries. In a retrospective analysis of 1275 patients who underwent an open lumbar spine operation compared with 791 who underwent MIS, the authors found a decreased incidence of surgical site infection in MIS surgeries (odds ratio = 0.580).[
Ten MIS microdiscectomies were compared with 10 traditional microdiscectomies performed by three spine surgeons at the UCLA-Santa Monica Orthopedic Hospital. Sites for bacterial swabs (BD Liquid Amies Elution Swab (ESwab); Becton, Dickinson and Company, Sparks, MD) were predetermined and are listed in
Cultures were grown on BD Columbia Blood Agar (VWR, West Chester, PA) for 48 hours at 37°C before colony counts were performed. One research technician performed counts uniformly. Columbia blood agar is a nonselective media that can culture both aerobic and anaerobic microorganisms.[
Average total mean colony counts are shown in
Our results indicate that there is very little bacterial contamination within the surgical field for either MIS or traditionally performed microdiscectomies. Additionally, there was no statistically significant difference in contamination between the two types of surgeries. Sampling within the surgical field revealed very little baseline growth and the averages shown in
Studies have suggested that in longer surgeries, equipment that is further away from the sterile field is associated with an increased risk of contamination.[
In our case-controlled study of traditional compared with minimally invasive microdiscectomies, we found no difference in contamination inside the surgical field and in both approaches there was minimal contamination.
The authors thank resident and fellows, Drs. Ausaf Bari, Michael Dorsi, Jason Hauptman, Brandon Rebholz, and Jonathan Pribaz for allowing them to collect samples during their surgeries. The authors also thank Dr. Romney Humphreys for her help with microbiological sampling. Funding for this research was made possible by the Yang Family Foundation.
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