Table 1.

Disparities between the current practice and the NASS recommendations.

Research question	NASS 2013 recommendations	Current practice
A. Efficacy
For patients undergoing spine surgery, does antibiotic prophylaxis result in decreased infection rates?	Preoperative prophylactic antibiotics are suggested to decrease infection rates in patients undergoing spine surgery.	Prophylactic antibiotics were given to patients undergoing spine surgeries.
	Grade of recommendation: B
	For a typical, uncomplicated lumbar laminotomy and discectomy, a single preoperative dose of antibiotics is suggested to decrease the risk of infection and/or discitis.	A single preoperative dose is not the current practice. Prolonged use >48 h was the common practice.
	Grade of recommendation: B
For patients undergoing spine surgery without spinal implants, does antibiotic prophylaxis result in decreased infection rates?	Prophylactic antibiotics are suggested to decrease the rate of spinal infections following un-instrumented lumbar spinal surgery.	Agree
	Grade of recommendation: B
B. Protocol
For patients receiving antibiotic prophylaxis prior to spine surgery without spinal implants, what are the recommended drugs, their dosages, and time of administration resulting in decreased postoperative infection rates?	Preoperative antibiotic prophylaxis is suggested to decrease infection rates in patients undergoing spine surgery without spinal implants. In these typical, uncomplicated spinal procedures, the superiority of one agent, dose, or route of administration over any other has not been demonstrated. When determining the appropriate drug choice, the patient’s risk factors, allergies, length and complexity of the procedure, and issues of antibiotic resistance should be considered.	Tendency to use third-generation cephalosporins or combination of antibiotics.
	Grade of recommendation: B
C. Redosing
For patients receiving antibiotic prophylaxis prior to spine surgery, what are the intraoperative redosing recommendations for the recommended drugs (including dosages and time of administration) resulting in decreased postoperative infection rates?	Consensus statement: Intraoperative redosing within 3–4 h may be considered to maintain therapeutic antibiotic levels throughout the procedure. The superiority of one drug has not been demonstrated in the literature. When determining the appropriate drug choice, the patient’s risk factors, allergies, length and complexity of the procedure, and issues of antibiotic resistance should be considered.	Agree
D. Discontinuation
For patients receiving antibiotic prophylaxis prior to spine surgery, does discontinuation of prophylaxis at 24 h result in decreased, or increased postoperative infection rates as compared to longer periods of administration?	For typical, uncomplicated cases, a single dose of preoperative prophylactic antibiotics with intraoperative redosing as needed is suggested to decrease the risk of SSI.	Prolonged postoperative regimens up to 14 days is the common practice.
	Grade of recommendation: B
	Prolonged postoperative regimens may be considered in complex situations (i.e., trauma, cord injury, neuromuscular disease, diabetes, or other co-morbidities).
	Grade of recommendation: C
E. Body habitus
For patients receiving antibiotic prophylaxis prior to spine surgery, should the recommended protocol differ based upon body habitus (e.g., body mass index)?	Obese patients are at higher risk for postoperative infection when given a standardized dose of antibiotic prophylaxis.	Prolonged regimen in obese patients is the common practice.
	Despite this conclusion, there is insufficient evidence to make a recommendation for or against recommending a different protocol for patients based upon body habitus.
	Grade of recommendation: I (insufficient evidence)