Comparison of Closed Irrigation and Drainage vs Repeated Wound Dressing Changes for Iliac Crest Bone Donor Site Infection in Spine Surgery.

Abstract

Objective: Bone donor site infection (BDSI) is a main complication of bone harvest in spine surgery. Traditionally, repeated wound dressing changes (RWDC) after debridement are commonly used to treat BDSI but are associated with significant pain and largely prolonged hospitalization. This study retrospectively compared the effectiveness of closed irrigation and drainage (CIAD) with RWDC in treating BDSI.

Methods: A total of 21 cases of BDSI secondary to different spinal procedures in a period of 15 years were included. Twelve cases were treated by RWDC in the earlier study period, and the other 9 cases were treated by CIAD in the later period. Detailed information about pre- and intra-operative characters, laboratory results, pathogens results, duration of antibiotics use, visual analog scale (VAS) score of donor site pain, total hospital stay, cost after primary operation, and final outcomes of the BDSI were collected.

Results: No significant difference was found among the included baseline characters. All patients obtained wound healing and no reinfection was found during a minimum of one year's follow-up. However, compared to RWDC, CIAD was associated with reduced hospital stay (16.5 ± 3.8 days versus 23.7 ± 4.9 days, P < 0.05), shorter duration of antibiotic use (5.3 ± 1.7 weeks versus 6.7 ± 2.0 weeks) and lower medical cost after primary operation (5040 ± 678 yuan versus 7280 ± 701 yuan, P < 0.05). While the VAS scores of donor site pain on the day a BDSI was diagnosed did not differ in the two groups, they were significantly lower on day 3, day 7, and even on the discharge day in the CIAD group.

Conclusion: CIAD displays significant superiority to RWDC for the treatment of BDSI in terms of hospital stay, antibiotic duration, cost, and pain relief.