Antibiotic envelopes appear safe and effective in decreasing SCS surgical site infection risks

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scs surgical infection
Jonathan M Hagedorn

Antibiotic impregnated envelopes appear to be a safe and effective modality for decreasing surgical site infection risks in spinal cord stimulation (SCS) implantation, according to study data published in Journal of Pain Research.

The report, which is authored by Jonathan M Hagedorn (Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, USA) and colleagues, states that surgical site infections in patients who undergo spinal cord stimulator implantation represent a “significant concern in terms of increased healthcare costs and patient morbidity”—but that the use of antibacterial envelopes to minimise this risk has not been previously described.

As such, Hagedorn et al conducted a retrospective review to evaluate this approach and its effectiveness when used adjunctively to standard infection prevention measures. The study included 52 patients (average age=62.2 years, 51.9% female), all of whom were implanted with a spinal cord stimulator between January 2015 and November 2020, and had the single-use, multifilament mesh TYRX absorbable antibacterial envelope (Medtronic) utilised at the time of surgery.

Data were collected and analysed on 52 permanent SCS implantations, which included 26 primary implantations and 26 revision surgeries. All patient data were collected at least three months postoperative from their implant surgery, while the average follow-up time period was 518.4 days. Hagedorn and colleagues report that there were no surgical site infections reported in the 52-patient cohort. Additionally, the authors state that there were no surgical complications encountered from the use of the antibacterial envelope, including delayed or interrupted wound healing, skin irritation, allergic reactions, seroma or haematoma formation, or increased postoperative pain.

“The results presented in this retrospective review suggest that use of an absorbable antibacterial envelope may be effective in reducing the risk of surgical site infection in primary and revision SCS implant surgeries,” the authors conclude. “Additionally, careful assessment of comorbid perioperative risk factors may play a crucial role when establishing interventions for infection prevention.

“Implantation of SCS therapies is rising, and the surgical volume is projected to continue on an upward trajectory as new indications and technologies emerge.” Hagedorn et al add that understanding and mitigating surgical complications like surgical site infection to the maximal degree possible is “essential for the continued success of the field”.


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