Intraoperative lavage using 0.05% chlorhexidine gluconate to prevent surgical site infections in lumbar decompressive instrumented fusion

Introduction: Spinal surgical site infections (SSIs) remain a significant complication following spine surgery, with an incidence ranging between 0.7–16.1% depending on risk factors present. Recent interest in surgical site wound decontamination, particularly in the context of SSI and reoperation prevention, has prompted research efforts. The objective of this work is to compare one commonly used intraoperative irrigation method, normal saline (NSS), with intraoperative chlorhexidine (CHG) irrigation.

Methods: We performed a retrospective cohort review of electronic medical records of patients who underwent lumbar spine instrumentation from January 2018 to January 2024. Group A were patients that were irrigated intraoperatively with 0.9% NSS and Group B were patients that were irrigated intraoperatively with sterile 0.05% CHG. All patients were evaluated at the clinics at 2, 4, and 12 weeks postoperatively for any signs of SSIs. Surgical characteristics, fusion at one year, and the need for reoperation were also reported.

Results: For our cohort, mean age for Group A (n=228) was 63.0 ± 10.6 years and in Group B (n=220), 61.2 ± 12.4 years. SSI at 4 weeks post-op was reported in 16 patients (7.0%) in Group A and in 3 patients (1.4%) in Group B (p-value= 0.006). At 12 weeks post-op, SSIs were only reported in 2 patients (0.9%) in Group A. During the study period, 10 patients had to be reoperated due to persistent infection: 9 patients (4%) in Group A and 1 patient in Group B (p-value= 0.02). At 1-year post-op, spinal fusion was achieved in 91.2% of patients in Group A and in 93.2% of patients in Group B.

Conclusion : The findings of this study suggest that intraoperative lavage using CHG is associated to decreased incidence of SSI following lumbar spine instrumentation when compared to NSS and, more importantly, reduced incidence of reoperation for cleansing and debridement.