{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:53:19Z","timestamp":1793105599536,"version":"4.5.0"},"reference-count":43,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2025-24683650"],"award-info":[{"award-number":["RS-2025-24683650"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,17]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the impact of restrictive prophylactic antibiotic guidelines on the incidence of surgical site infections (SSIs) following elective spinal surgery using nationwide quality assessment data from South Korea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nationwide retrospective cohort study comparing SSI rates between unrestricted (seventh and eighth quality assessment waves) and restricted (ninth wave) prophylactic antibiotic guideline periods using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All healthcare institutions performing elective spinal surgery and participating in the Health Insurance Review and Assessment Service (HIRA) quality assessment programme in South Korea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 58\u2009829 adult patients who underwent elective spinal surgery during the seventh (2015), eighth (2017) and ninth (2020) HIRA quality assessment waves were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the incidence of post-operative SSIs. Secondary outcomes included non-surgical site infections and factors associated with SSI occurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall post-operative infection rate was 5.79%. The incidence of SSIs was significantly higher in the restricted antibiotic group than in the unrestricted group (2.41% vs 0.84%). In multivariable logistic regression analysis, restrictive prophylactic antibiotic use was independently associated with an increased risk of SSIs (adjusted OR, 2.48; 95%\u2009CI 2.13 to 2.89; p&lt;0.001). When stratified by hospital type, patients treated in tertiary hospitals had the highest SSI risk (adjusted OR, 4.47; 95%\u2009CI 3.65 to 5.47), followed by those treated in general hospitals (adjusted OR, 3.03; 95%\u2009CI 2.55 to 3.60) (all p&lt;0.001). Non-surgical site infections were also more frequent in the restricted group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Restrictive prophylactic antibiotic guidelines were associated with a higher incidence of post-operative infections following elective spinal surgery. These findings suggest that prophylactic antibiotic strategies may need to consider patient risk profiles and surgical complexity rather than applying a uniform approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107941","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:40:43Z","timestamp":1772203243000},"page":"e107941","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of restricted prophylactic antibiotic guidelines on surgical site infection rates following spinal surgery in Korea: a nationwide cohort analysis"],"prefix":"10.1136","volume":"16","author":[{"given":"Young-Hoon","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youngjin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukil","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Il","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo-Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service, Wonju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0084-8867","authenticated-orcid":false,"given":"Hyung-Youl","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"2026022706403640000_16.2.e107941.1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.2106\/JBJS.21.00751","article-title":"A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery","volume":"104","author":"Matsumoto","year":"2022","journal-title":"J Bone Joint Surg Am"},{"key":"2026022706403640000_16.2.e107941.2","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.2106\/JBJS.20.02141","article-title":"The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders","volume":"103","author":"Urquhart","year":"2021","journal-title":"J Bone Joint Surg Am"},{"key":"2026022706403640000_16.2.e107941.3","doi-asserted-by":"crossref","unstructured":"Chen J-J , Lin H-H , Chou P-H , et al . 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