{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:47:49Z","timestamp":1792792069865,"version":"4.5.0"},"reference-count":45,"publisher":"Elsevier BV","issue":"9","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thespinejournalonline.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Spine Journal"],"published-print":{"date-parts":[[2022,9]]},"DOI":"10.1016\/j.spinee.2022.05.018","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T11:57:35Z","timestamp":1654516655000},"page":"1442-1450","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":21,"title":["Cefazolin prophylaxis in spine surgery: patients are frequently underdosed and at increased risk for infection"],"prefix":"10.1016","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0512-6019","authenticated-orcid":false,"given":"Brian A.","family":"Karamian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory R.","family":"Toci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Lambrechts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Siegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3258-3568","authenticated-orcid":false,"given":"Matthew","family":"Sherman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2152-5725","authenticated-orcid":false,"given":"Jose A.","family":"Canseco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S.","family":"Hilibrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K.","family":"Kepler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Schroeder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.spinee.2022.05.018_bib0001","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/BRS.0000000000003218","article-title":"Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis","volume":"45","author":"Zhou","year":"2020","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2022.05.018_bib0002","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/BRS.0000000000002277","article-title":"The effect of postoperative spinal infections on patient mortality","volume":"43","author":"Casper","year":"2018","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2022.05.018_bib0003","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/BRS.0b013e31818ed75e","article-title":"Failure of attempted implant retention in spinal deformity delayed surgical site infections","volume":"34","author":"Hedequist","year":"2009","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2022.05.018_bib0004","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1093\/neuros\/nyw066","article-title":"Prevention of surgical site infection in spine surgery","volume":"80","author":"Anderson","year":"2017","journal-title":"Neurosurgery"},{"key":"10.1016\/j.spinee.2022.05.018_bib0005","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00006123-200208000-00017","article-title":"Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis","volume":"51","author":"Barker","year":"2002","journal-title":"Neurosurgery"},{"key":"10.1016\/j.spinee.2022.05.018_bib0006","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2106\/00004623-197052010-00008","article-title":"Prophylactic penicillin in orthopaedic surgery","volume":"52","author":"Fogelberg","year":"1970","journal-title":"J Bone Jt Surg Am"},{"key":"10.1016\/j.spinee.2022.05.018_bib0007","doi-asserted-by":"crossref","first-page":"777","DOI":"10.2106\/00004623-197456040-00011","article-title":"Prophylactic antibiotics in clean orthopaedic surgery","volume":"56","author":"Pavel","year":"1974","journal-title":"J Bone Jt Surg Am"},{"key":"10.1016\/j.spinee.2022.05.018_bib0008","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.spinee.2008.05.008","article-title":"Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery","volume":"9","author":"Watters","year":"2009","journal-title":"Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0009","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1017\/S019594170005709X","article-title":"Perioperative prophylactic use of antibiotics in surgery: principles and practice","volume":"3","author":"Shapiro","year":"1982","journal-title":"Infect Control"},{"key":"10.1016\/j.spinee.2022.05.018_bib0010","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1056\/NEJM199201303260501","article-title":"The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection","volume":"326","author":"Classen","year":"1992","journal-title":"New Engl J Med"},{"key":"10.1016\/j.spinee.2022.05.018_bib0011","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/SLA.0b013e3181ad5fca","article-title":"Timing of antimicrobial prophylaxis and the risk of surgical site infections","volume":"250","author":"Steinberg","year":"2009","journal-title":"Ann Surg"},{"key":"10.1016\/j.spinee.2022.05.018_bib0012","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1056\/NEJMsa0810119","article-title":"A surgical safety checklist to reduce morbidity and mortality in a global population","volume":"360","author":"Haynes","year":"2009","journal-title":"New Engl J Med"},{"key":"10.1016\/j.spinee.2022.05.018_bib0013","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1128\/AAC.4.4.396","article-title":"Bactericidal activity and pharmacology of cefazolin","volume":"4","author":"Bergeron","year":"1973","journal-title":"Antimicrob Agents Ch"},{"key":"10.1016\/j.spinee.2022.05.018_bib0014","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical practice guidelines for antimicrobial prophylaxis in surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am J Health-Syst Ph"},{"key":"10.1016\/j.spinee.2022.05.018_bib0015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1089\/sur.2010.097","article-title":"Cefazolin dosing for surgical prophylaxis in morbidly obese patients","volume":"13","author":"Ho","year":"2012","journal-title":"Surg Infect"},{"key":"10.1016\/j.spinee.2022.05.018_bib0016","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1089\/sur.2019.039","article-title":"Lack of pharmacokinetic basis of weight-based dosing and intra-operative re-dosing with cefazolin surgical prophylaxis in obese patients: implications for antibiotic stewardship","volume":"20","author":"Blum","year":"2019","journal-title":"Surg Infect"},{"key":"10.1016\/j.spinee.2022.05.018_bib0017","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.ijantimicag.2016.08.019","article-title":"Evaluation of total body weight and body mass index cut-offs for increased cefazolin dose for surgical prophylaxis","volume":"48","author":"Hites","year":"2016","journal-title":"Int J Antimicrob Ag"},{"key":"10.1016\/j.spinee.2022.05.018_bib0018","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1592\/phco.27.8.1081","article-title":"Antimicrobial dosing considerations in obese adult patients","volume":"27","author":"Pai","year":"2007","journal-title":"Pharmacother J Hum Pharmacol Drug Ther"},{"key":"10.1016\/j.spinee.2022.05.018_bib0019","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1001\/jama.2018.3060","article-title":"Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016","volume":"319","author":"Hales","year":"2018","journal-title":"JAMA"},{"key":"10.1016\/j.spinee.2022.05.018_bib0020","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/BOT.0000000000001171","article-title":"The effect of under-dosing prophylactic antibiotics in the care of open tibial fractures","volume":"32","author":"Olinger","year":"2018","journal-title":"J Orthop Trauma"},{"key":"10.1016\/j.spinee.2022.05.018_bib0021","doi-asserted-by":"crossref","first-page":"3551","DOI":"10.1016\/j.arth.2018.06.037","article-title":"Cefazolin prophylaxis for total joint arthroplasty: obese patients are frequently underdosed and at increased risk of periprosthetic joint infection","volume":"33","author":"Rondon","year":"2018","journal-title":"J Arthroplast"},{"key":"10.1016\/j.spinee.2022.05.018_bib0022","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1007\/s11999-017-5302-0","article-title":"Vancomycin prophylaxis for total joint arthroplasty: incorrectly dosed and has a higher rate of periprosthetic infection than cefazolin","volume":"475","author":"Kheir","year":"2017","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.spinee.2022.05.018_bib0023","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1097\/BRS.0b013e318154c57e","article-title":"Anterior cervical discectomy and fusion associated complications","volume":"32","author":"Fountas","year":"2007","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2022.05.018_bib0024","series-title":"National healthcare safety network","year":"2022"},{"key":"10.1016\/j.spinee.2022.05.018_bib0025","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.surneu.2007.08.017","article-title":"Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion\u2014a prospective study","volume":"70","author":"Hellbusch","year":"2008","journal-title":"Surg Neurol"},{"key":"10.1016\/j.spinee.2022.05.018_bib0026","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.wneu.2015.05.059","article-title":"Risk factors for surgical site infection after spinal surgery: a meta-analysis","volume":"95","author":"Fei","year":"2016","journal-title":"World Neurosurg"},{"key":"10.1016\/j.spinee.2022.05.018_bib0027","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1186\/s12879-018-3418-9","article-title":"Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible staphylococcus aureus bacteremia: a systematic review and meta-analysis","volume":"18","author":"Shi","year":"2018","journal-title":"Bmc Infect Dis"},{"key":"10.1016\/j.spinee.2022.05.018_bib0028","series-title":"Global guidelines for the prevention of surgical site infection","year":"2018"},{"key":"10.1016\/j.spinee.2022.05.018_bib0029","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/S1473-3099(20)30084-0","article-title":"Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: a systematic review and meta-analysis","volume":"20","author":"Jonge","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"10.1016\/j.spinee.2022.05.018_bib0030","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"Jama Surg"},{"key":"10.1016\/j.spinee.2022.05.018_bib0031","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3928\/0147-7447-20010701-15","article-title":"Pharmacokinetics of antibiotic prophylaxis in major orthopedic surgery and blood-saving techniques","volume":"7","author":"Dehne","year":"2001","journal-title":"Orthopedics"},{"key":"10.1016\/j.spinee.2022.05.018_bib0032","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1007\/s00595-005-3026-3","article-title":"The significance of the intraoperative repeated dosing of antimicrobials for preventing surgical wound infection in colorectal surgery","volume":"35","author":"Morita","year":"2005","journal-title":"Surg Today"},{"key":"10.1016\/j.spinee.2022.05.018_bib0033","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/BF02482213","article-title":"An additional dose of cefazolin for intraoperative prophylaxis","volume":"29","author":"Ohge","year":"1999","journal-title":"Surg Today"},{"key":"10.1016\/j.spinee.2022.05.018_bib0034","doi-asserted-by":"crossref","first-page":"2800","DOI":"10.1007\/s00586-013-2890-6","article-title":"Body mass index and risk of surgical site infection following spine surgery: a meta-analysis","volume":"22","author":"Abdallah","year":"2013","journal-title":"Eur Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0035","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.spinee.2017.11.015","article-title":"Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness","volume":"18","author":"Bono","year":"2018","journal-title":"Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0036","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.spinee.2015.12.009","article-title":"Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005\u20132012","volume":"16","author":"Sebastian","year":"2016","journal-title":"Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0037","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1016\/j.jocn.2015.03.065","article-title":"Risk factors for surgical site infections following spinal surgery","volume":"22","author":"Meng","year":"2015","journal-title":"J Clin Neurosci"},{"key":"10.1016\/j.spinee.2022.05.018_bib0038","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1097\/BRS.0b013e318246a53a","article-title":"Surgical site infection in spinal surgery","volume":"37","author":"Abdul-Jabbar","year":"2012","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2022.05.018_bib0039","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/2192568218789117","article-title":"Longer operative time in elderly patients undergoing posterior lumbar fusion is independently associated with increased complication rate","volume":"9","author":"Hersey","year":"2019","journal-title":"Global Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0040","doi-asserted-by":"crossref","first-page":"2710","DOI":"10.1016\/j.spinee.2014.03.011","article-title":"Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery","volume":"14","author":"Emohare","year":"2014","journal-title":"Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0041","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1097\/BRS.0b013e31828fcfb5","article-title":"Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion","volume":"38","author":"Caroom","year":"2013","journal-title":"Spine"},{"key":"10.1016\/j.spinee.2022.05.018_bib0042","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1016\/j.spinee.2019.05.592","article-title":"The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery","volume":"19","author":"Lemans","year":"2019","journal-title":"Spine J"},{"key":"10.1016\/j.spinee.2022.05.018_bib0043","doi-asserted-by":"crossref","first-page":"490","DOI":"10.2106\/JBJS.K.00471","article-title":"Efficacy of surgical preparation solutions in lumbar spine surgery","volume":"94","author":"Savage","year":"2012","journal-title":"J Bone Jt Surg"},{"key":"10.1016\/j.spinee.2022.05.018_bib0044","doi-asserted-by":"crossref","first-page":"e700","DOI":"10.1016\/j.wneu.2021.04.094","article-title":"Prevention of surgical site infection in lumbar instrumented fusion using a sterile povidone-iodine solution","volume":"151","author":"Cuello","year":"2021","journal-title":"World Neurosurg"},{"key":"10.1016\/j.spinee.2022.05.018_bib0045","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.spinee.2021.07.008","article-title":"Nasal screening for methicillin-resistant staphylococcus aureus does not reduce surgical site infection after primary lumbar fusion","volume":"22","author":"Xiong","year":"2022","journal-title":"Spine J"}],"container-title":["The Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S152994302200242X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S152994302200242X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:36:35Z","timestamp":1761514595000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S152994302200242X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":45,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["S152994302200242X"],"URL":"https:\/\/doi.org\/10.1016\/j.spinee.2022.05.018","relation":{},"ISSN":["1529-9430"],"issn-type":[{"value":"1529-9430","type":"print"}],"subject":[],"published":{"date-parts":[[2022,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Cefazolin prophylaxis in spine surgery: patients are frequently underdosed and at increased risk for infection","name":"articletitle","label":"Article Title"},{"value":"The Spine Journal","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.spinee.2022.05.018","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}