Prophylactic Antibiotics

The median total antibiotic duration was lower in the restricted group (137 hours, IQR 25–231) than in the unrestricted group (152 hours, IQR 84–248), with the first quartile falling sharply to 25 hours. The ninth QA wave restricted prophylactic antibiotics to first- or second-generation cephalosporins, with a strict 24-hour postoperative duration limit except in cases of documented allergy. Across all QA waves, initial prophylactic antibiotic administration was required within 1 hour before skin incision. The ideal prophylactic antibiotic agent, timing, and duration for spinal surgery remain debated despite widespread acceptance of prophylaxis for reducing SSI. Antibiotic duration under 120 hours in the restricted group was associated with a sharply increased SSI risk (OR 5.31, 95% CI 2.71–10.41). Adherence to the recommended restricted antibiotic guidelines was associated with higher SSI incidence compared with the unrestricted group (OR 2.27). Use of a single cephalosporin regimen in the restricted group was associated with higher SSI incidence (OR 3.17).