Effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Hao ^1,2 , YANG Junsong ¹ , LIU Tuanjiang ¹ , TIAN Ye ^1,2 , DING Keyuan ^1,2 , ZHOU Yumin ³ , HUANG Dageng ¹ ,  HAO Dingjun ¹

1. Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;
2. Xi’an Medical University, Xi’an Shaanxi, 710021, P.R.China;
3. Department of Rehabilitation, Shanghai Fifth People’s Hospital, Shanghai, 200240, P.R.China;

Corresponding author：

HAO Dingjun, Email: haodingjun@126.com

Keywords：

Hydrogen peroxide; lumbar degenerative disease; infection; postoperative drainage volume

DOI：

10.7507/1002-1892.201905049

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Objective To investigate the effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery.Methods A clinical data of 510 patients with multi-segmental lumbar degenerative diseases who were treated with surgery between January 2017 and January 2018 was retrospectively analyzed. In study group, the incisions of 230 cases were washed with hydrogen peroxide before suture. In control group, the incisions of 280 cases were washed with normal saline before suture. There was no significant difference in gender, age, lesion type, disease duration, operative segment, and other clinical data between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and postoperative incidence of infection were recorded and compared between the two groups. The Centers for Disease Control and Prevention (CDC) standard was used to evaluate infection, which was divided into superficial infection and deep infection.Results All operations completed successfully. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative drainage volume in the study group was significantly less than that in the control group (t=−2.990, P=0.005). A total of 13 patients developed infection after operation, including 10 cases of superficial infection (2 cases in the study group and 8 cases in the control group) with the infection time of (7.3±1.5) days, and 3 cases of deep infection (all in the control group) with the infection time of (16.6±3.1) days. The incidences of superficial and deep infections in the study group were lower than those in the control group, but there was no significant difference between the two groups (χ²=2.595, P=0.123; P=0.256). All the superficial infections were Staphylococcus aureus infection and recovered after active dressing change. Among the patients with deep infections, 2 cases were infected by Staphylococcus aureus and 1 case was infected by Escherichia coli; and the incisions healed after being washed and sutured thoroughly, and active dressing change.Conclusion The incidence of postoperative infection and postoperative drainage volume can be reduced by washing the incision with hydrogen peroxide in multi-segmental lumbar surgery.

Citation： CHEN Hao, YANG Junsong, LIU Tuanjiang, TIAN Ye, DING Keyuan, ZHOU Yumin, HUANG Dageng, HAO Dingjun. Effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 313-317. doi: 10.7507/1002-1892.201905049 Copy

1.	Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect, 2008, 70(Suppl 2): 3-10.
2.	Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord, 2000, 13(5): 422-426.
3.	Yao R, Tan T, Tee JW, et al. Prophylaxis of surgical site infection in adult spine surgery: A systematic review. J Clin Neurosci, 2018, 52: 5-25.
4.	Veziant J, Raspado O, Entremont A, et al. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg, 2017, 154(3): 159-166.
5.	Ohlin A, Mattsson E, Mörgelin M, et al. Titanium granules pre-treated with hydrogen peroxide inhibit growth of bacteria associated with post-operative infections in spine surgery. Eur Spine J, 2018, 27(10): 2463-2468.
6.	Altun H, Hancı D, Kumral TL, et al. The hemostatic efficacy of hydrogen peroxide irrigation to control intraoperative bleeding in adenoidectomy. Turk Arch Otorhinolaryngol, 2018, 56(4): 193-198.
7.	Hey HW, Thiam DW, Koh ZS, et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine (Phila Pa 1976), 2017, 42(4): 267-274.
8.	Schroeder JE, Girardi FP, Sandhu H, et al. The use of local vancomycin powder in degenerative spine surgery. Eur Spine J, 2016, 25(4): 1029-1033.
9.	Litrico S, Recanati G, Gennari A, et al. Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study. Eur J Orthop Surg Traumatol, 2016, 26(1): 21-26.
10.	Shousha M, Cirovic D, Boehm H. Infection rate after minimally invasive noninstrumented spinal surgery based on 4350 procedures. Spine (Phila Pa 1976), 2015, 40(3): 201-205.
11.	Xie J, Lenke LG, Li T, et al. Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery. Spine J, 2015, 15(4): 647-654.
12.	Tayyab NA, Mariller MM, Rivlin M, et al. Efficacy of aprotinin as a blood conservation technique for adult deformity spinal surgery: a retrospective study. Spine (Phila Pa 1976), 2008, 33(16): 1775-1781.
13.	Cole JW, Murray DJ, Snider RJ, et al. Aprotinin reduces blood loss during spinal surgery in children. Spine (Phila Pa 1976), 2003, 28(21): 2482-2485.
14.	Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of cdc definitions of surgical wound infections. Am J Infect Control, 1992, 13(10): 606-608.
15.	Mei Q, Ye Y, Zhu YL, et al. Use of Monte Carlo simulation to evaluate the development of vancomycin resistance in meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents, 2015, 45(6): 652-656.
16.	Çıkman A, Aydın M, Gülhan B, et al. Investigation of antibiotic resistance patterns and reduced vancomycin susceptibilities of methicillin-resistant Staphylococcus aureus isolates: a multi-center study. Mikrobiyol Bul, 2015, 49(2): 240-248.
17.	Murphy EP, Curtin M, Shafqat A, et al. A review of the application of vancomycin powder to posterior spinal fusion wounds with a focus on side effects and infection. A prospective study. Eur J Orthop Surg Traumatol, 2017, 27(2): 187-191.
18.	Evaniew N, Khan M, Drew B, et al. Intrawound vancomycin to prevent infections after spine surgery: a systematic review and meta-analysis. Eur Spine J, 2015, 24(3): 533-542.
19.	Tsubouchi N, Fujibayashi S, Otsuki B, et al. Risk factors for implant removal after spinal surgical site infection. Eur Spine J, 2018, 27(10): 2481-2490.
20.	Farshad M, Bauer DE, Wechsler C, et al. Risk factors for perioperative morbidity in spine surgeries of different complexities: a multivariate analysis of 1,009 consecutive patients. Spine J, 2018, 18(9): 1625-1631.
21.	Niethammer P, Grabher C, Look AT, et al. A tissue-scale gradient of hydrogen peroxide mediates rapid wound detection in zebrafish. Nature, 2009, 459(7249): 996-999.
22.	Ulivieri S, Toninelli S, Petrini C, et al. Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone-iodine and hydrogen peroxide. Arch Orthop Trauma Surg, 2011, 131(9): 1203-1206.
23.	Lee MJ, Cizik AM, Hamilton D, et al. Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry. Spine J, 2014, 14(9): 2112-2117.
24.	Gerstein NS, Deriy L, Patel PA. Tranexamic acid use in cardiac surgery: hemostasis, seizures, or a little of both. J Cardiothorac Vasc Anesth, 2018, 32(4): 1635-1637.
25.	Kim KT, Kim CK, Kim YC, et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J, 2017, 26(11): 2851-2857.
26.	李锐博, 尹诗九, 钟航, 等. 静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价. 中国修复重建外科杂志, 2017, 31(4): 417-421.
27.	Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet, 2018, 391(10135): 2107-2115.
28.	Murkin JM, Falter F, Granton J, et al. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg, 2010, 110(2): 350-353.
29.	Martin K, Wiesner G, Breuer T, et al. The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg, 2008, 107(6): 1783-1790.
30.	Mangano DT, Tudor IC, Dietzel C, et al. The risk associated with aprotinin in cardiac surgery. N Engl J Med, 2006, 354(4): 353-365.
31.	Okubadejo GO, Bridwell KH, Lenke LG, et al. Aprotinin may decrease blood loss in complex adult spinal deformity surgery, but it may also increase the risk of acute renal failure. Spine (Phila Pa 1976), 2007, 32(20): 2265-2271.
32.	Zou H, Li Z, Sheng H, et al. Intraoperative blood loss, postoperative drainage, and recovery in patients undergoing lumbar spinal surgery. BMC Surg, 2015, 15: 76.
33.	Foss-Skiftesvik J, Bech-Azeddine R. Topical haemostatic agents in neurosurgery. Ugeskr Laeger, 2017, 179(5): V07160497.
34.	Baillat X, Mathieu-Daude P, Macabies J. Study of hepatic oxygenation by hydrogen peroxide solutions. Ⅰ. Effects of hydrogen peroxide on blood. J Physiol (Paris), 1970, 62(Suppl 1): 116-117.
35.	Patankar PS, Joshi SS, Choudhari KA. Air-embolism and cerebral ischaemia following epidural hydrogen peroxide irrigation in a closed lumbar cavity. Br J Neurosurg, 2014, 28(4): 556-558.
36.	Morikawa H, Mima H, Fujita H, et al. Oxygen embolism due to hydrogen peroxide irrigation during cervical spinal surgery. Can J Anaesth, 1995, 42(3): 231-233.
37.	Chhabra R, Pathak A, Ray P. Fatal posterior fossa pneumocephalus due to hydrogen peroxide irrigation of lumbar wound. Br J Neurosurg, 2000, 14(6): 549-551.
38.	Kleffmann J, Ferbert A, Deinsberger W, et al. Extensive ischemic brainstem lesions and pneumocephalus after application of hydrogen peroxide (H2O2) during lumbar spinal surgery. Spine J, 2015, 15(4): e5-e7.
39.	Lu M, Hansen EN. Hydrogen peroxide wound irrigation in orthopaedic surgery. J Bone Jt Infect, 2017, 2(1): 3-9.

1. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect, 2008, 70(Suppl 2): 3-10.
2. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord, 2000, 13(5): 422-426.
3. Yao R, Tan T, Tee JW, et al. Prophylaxis of surgical site infection in adult spine surgery: A systematic review. J Clin Neurosci, 2018, 52: 5-25.
4. Veziant J, Raspado O, Entremont A, et al. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg, 2017, 154(3): 159-166.
5. Ohlin A, Mattsson E, Mörgelin M, et al. Titanium granules pre-treated with hydrogen peroxide inhibit growth of bacteria associated with post-operative infections in spine surgery. Eur Spine J, 2018, 27(10): 2463-2468.
6. Altun H, Hancı D, Kumral TL, et al. The hemostatic efficacy of hydrogen peroxide irrigation to control intraoperative bleeding in adenoidectomy. Turk Arch Otorhinolaryngol, 2018, 56(4): 193-198.
7. Hey HW, Thiam DW, Koh ZS, et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine (Phila Pa 1976), 2017, 42(4): 267-274.
8. Schroeder JE, Girardi FP, Sandhu H, et al. The use of local vancomycin powder in degenerative spine surgery. Eur Spine J, 2016, 25(4): 1029-1033.
9. Litrico S, Recanati G, Gennari A, et al. Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study. Eur J Orthop Surg Traumatol, 2016, 26(1): 21-26.
10. Shousha M, Cirovic D, Boehm H. Infection rate after minimally invasive noninstrumented spinal surgery based on 4350 procedures. Spine (Phila Pa 1976), 2015, 40(3): 201-205.
11. Xie J, Lenke LG, Li T, et al. Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery. Spine J, 2015, 15(4): 647-654.
12. Tayyab NA, Mariller MM, Rivlin M, et al. Efficacy of aprotinin as a blood conservation technique for adult deformity spinal surgery: a retrospective study. Spine (Phila Pa 1976), 2008, 33(16): 1775-1781.
13. Cole JW, Murray DJ, Snider RJ, et al. Aprotinin reduces blood loss during spinal surgery in children. Spine (Phila Pa 1976), 2003, 28(21): 2482-2485.
14. Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of cdc definitions of surgical wound infections. Am J Infect Control, 1992, 13(10): 606-608.
15. Mei Q, Ye Y, Zhu YL, et al. Use of Monte Carlo simulation to evaluate the development of vancomycin resistance in meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents, 2015, 45(6): 652-656.
16. Çıkman A, Aydın M, Gülhan B, et al. Investigation of antibiotic resistance patterns and reduced vancomycin susceptibilities of methicillin-resistant Staphylococcus aureus isolates: a multi-center study. Mikrobiyol Bul, 2015, 49(2): 240-248.
17. Murphy EP, Curtin M, Shafqat A, et al. A review of the application of vancomycin powder to posterior spinal fusion wounds with a focus on side effects and infection. A prospective study. Eur J Orthop Surg Traumatol, 2017, 27(2): 187-191.
18. Evaniew N, Khan M, Drew B, et al. Intrawound vancomycin to prevent infections after spine surgery: a systematic review and meta-analysis. Eur Spine J, 2015, 24(3): 533-542.
19. Tsubouchi N, Fujibayashi S, Otsuki B, et al. Risk factors for implant removal after spinal surgical site infection. Eur Spine J, 2018, 27(10): 2481-2490.
20. Farshad M, Bauer DE, Wechsler C, et al. Risk factors for perioperative morbidity in spine surgeries of different complexities: a multivariate analysis of 1,009 consecutive patients. Spine J, 2018, 18(9): 1625-1631.
21. Niethammer P, Grabher C, Look AT, et al. A tissue-scale gradient of hydrogen peroxide mediates rapid wound detection in zebrafish. Nature, 2009, 459(7249): 996-999.
22. Ulivieri S, Toninelli S, Petrini C, et al. Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone-iodine and hydrogen peroxide. Arch Orthop Trauma Surg, 2011, 131(9): 1203-1206.
23. Lee MJ, Cizik AM, Hamilton D, et al. Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry. Spine J, 2014, 14(9): 2112-2117.
24. Gerstein NS, Deriy L, Patel PA. Tranexamic acid use in cardiac surgery: hemostasis, seizures, or a little of both. J Cardiothorac Vasc Anesth, 2018, 32(4): 1635-1637.
25. Kim KT, Kim CK, Kim YC, et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J, 2017, 26(11): 2851-2857.
26. 李锐博, 尹诗九, 钟航, 等. 静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价. 中国修复重建外科杂志, 2017, 31(4): 417-421.
27. Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet, 2018, 391(10135): 2107-2115.
28. Murkin JM, Falter F, Granton J, et al. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg, 2010, 110(2): 350-353.
29. Martin K, Wiesner G, Breuer T, et al. The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg, 2008, 107(6): 1783-1790.
30. Mangano DT, Tudor IC, Dietzel C, et al. The risk associated with aprotinin in cardiac surgery. N Engl J Med, 2006, 354(4): 353-365.
31. Okubadejo GO, Bridwell KH, Lenke LG, et al. Aprotinin may decrease blood loss in complex adult spinal deformity surgery, but it may also increase the risk of acute renal failure. Spine (Phila Pa 1976), 2007, 32(20): 2265-2271.
32. Zou H, Li Z, Sheng H, et al. Intraoperative blood loss, postoperative drainage, and recovery in patients undergoing lumbar spinal surgery. BMC Surg, 2015, 15: 76.
33. Foss-Skiftesvik J, Bech-Azeddine R. Topical haemostatic agents in neurosurgery. Ugeskr Laeger, 2017, 179(5): V07160497.
34. Baillat X, Mathieu-Daude P, Macabies J. Study of hepatic oxygenation by hydrogen peroxide solutions. Ⅰ. Effects of hydrogen peroxide on blood. J Physiol (Paris), 1970, 62(Suppl 1): 116-117.
35. Patankar PS, Joshi SS, Choudhari KA. Air-embolism and cerebral ischaemia following epidural hydrogen peroxide irrigation in a closed lumbar cavity. Br J Neurosurg, 2014, 28(4): 556-558.
36. Morikawa H, Mima H, Fujita H, et al. Oxygen embolism due to hydrogen peroxide irrigation during cervical spinal surgery. Can J Anaesth, 1995, 42(3): 231-233.
37. Chhabra R, Pathak A, Ray P. Fatal posterior fossa pneumocephalus due to hydrogen peroxide irrigation of lumbar wound. Br J Neurosurg, 2000, 14(6): 549-551.
38. Kleffmann J, Ferbert A, Deinsberger W, et al. Extensive ischemic brainstem lesions and pneumocephalus after application of hydrogen peroxide (H2O2) during lumbar spinal surgery. Spine J, 2015, 15(4): e5-e7.
39. Lu M, Hansen EN. Hydrogen peroxide wound irrigation in orthopaedic surgery. J Bone Jt Infect, 2017, 2(1): 3-9.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of hydrogen peroxide on anti-infection and reducing postoperative drainage in multi-segmental lumbar surgery

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