{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T03:17:28Z","timestamp":1789269448868,"version":"build-2803163510"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T00:00:00Z","timestamp":1700697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study is to investigate the efficacy of the GAID-Protocol, a bundle of intra- and postoperative infection prevention measures, to reduce implant-associated infections in patients undergoing posterior spinal fusion with instrumentation. These preventive measures are organized into a protocol that includes recommendations for four critical areas of implant protection (acronym GAID): Gloves, Antiseptics: sodium hypochlorite\/hypochlorous acid (NaOCl\/HOCl), Implants and Drainage-use in large wounds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a single-site retrospective review of cases undergoing posterior spinal fusion with instrumentation for primarily degenerative spinal diseases before and after implementation of the GAID-Protocol that was specifically designed to protect against implant-associated infections. The primary outcome was postoperative wound complications requiring surgical intervention, with a particular focus on infectious spondylitis\/discitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>230 cases were included: 92 (Group A) before and 138 (Group B) after protocol implementation. Overall, wound complications requiring surgical intervention occurred in 7.6% patients in Group A and in 3.6% patients in Group B (<jats:italic>p<\/jats:italic>\u2009=\u20090.2297). Of these, infectious spondylitis\/discitis was present in 5.4% in Group A and in none of Group B (<jats:italic>p<\/jats:italic>\u2009=\u20090.0096). The ratio of infectious spondylitis\/discitis to other wound problems was 71% to 29% in Group A, while it was 0% to 100% in Group B (<jats:italic>p<\/jats:italic>\u2009=\u20090.0278). The mean time interval between the first revision surgery for wound complications and hospital discharge was significantly different, 38 days SD 20.3 in Group A and 14.4 days SD 8.6 in Group B (<jats:italic>p<\/jats:italic>\u2009=\u20090.0442).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In our study, adherence to the GAID-Protocol resulted in a shift from severe to significantly less severe and easier to treat wound complications. Adoption of the GAID-Protocol might contribute to the reduction of implant-associated infections.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1308213","type":"journal-article","created":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T09:51:05Z","timestamp":1700733065000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevention of implant-associated spinal infections: the GAID-protocol"],"prefix":"10.3389","volume":"10","author":[{"given":"Joanna Maria","family":"Przybyl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldemar Andres","family":"Hegewald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1001\/jamasurg.2016.1794","article-title":"Implementation of 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