283. The efficacy and cost-effectiveness of photodynamic therapy in prevention of surgical site infection

Abstract

BACKGROUND CONTEXT Incidence rates of surgical site infection (SSI) following instrumented spine surgery vary from 1-9%. We have previously reported significant variability in SSI prevention practice amongst CSS members. Patient skin and nasal cavity colonization with MSSA remains a major risk factor. PURPOSE The purpose of this study was to investigate the efficacy and cost effectiveness of chlorhexidine skin decolonization (CSD) and nasal photo-disinfection therapy (nPDT) on surgical site infection. STUDY DESIGN/SETTING This prospective cohort study was performed at a single quaternary spine referral center. OUTCOME MEASURES SSI rates, microbiological data, treatment data and costs were prospectively recorded. Amongst the spine surgery cases, age, BMI, comorbidities, spine surgery invasiveness index (SSII), blood loss and adverse events (AE) were recorded using the SAVES2 system. METHODS Since 2009, as a local QI initiative at a quaternary referral center, all patients undergoing high risk surgery (including instrumented spine surgery, vascular, cardiothoracic and ortho trauma) received CSD and nPDT preoperatively. Data were prospectively collected in terms of outcome measures. RESULTS From 2009 to 2017 the SSI rate for spine cases decreased from 7.2% to 1.6%, the greatest magnitude of reduction of all surgery types (p 35 (RR 2.25), midline lumbar surgery vs cervical or thoracic (RR 2.2), cervical vs thoracic (RR 1.9), revision surgery (RR 2.9) and in those undergoing more complex instrumentation (SSII> 21) (RR 3.35). The use of CSD / nPDT was not associated with any additional AE's. CONCLUSIONS CSD / nPDT is both efficacious and cost-effective in preventing surgical site infection, particularly in complex instrumented cases in the highest risk patients. Given the minimal resource cost, we recommend the routine use of this technology for SSI prevention. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.