The impact of deep surgical site infection on surgical outcomes after posterior adult spinal deformity surgery: a matched control study

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

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Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

European Spine Journal ◽

10.1007/s00586-009-1269-1 ◽

2010 ◽

Vol 19 (6) ◽

pp. 982-988 ◽

Cited By ~ 75

Author(s):

Albert F. Pull ter Gunne ◽

C. J. H. M. van Laarhoven ◽

David B. Cohen

Keyword(s):

Surgical Site Infection ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Site Infection ◽

Patient Risk ◽

Spinal Deformity Surgery

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Risk Factors Associated with Surgical Site Infection in Pediatric Patients Undergoing Spinal Deformity Surgery

JBJS Reviews ◽

10.2106/jbjs.rvw.19.00163 ◽

2020 ◽

Vol 8 (3) ◽

pp. e0163

Author(s):

Hiroko Matsumoto ◽

Matthew E. Simhon ◽

Megan L. Campbell ◽

Michael G. Vitale ◽

Elaine L. Larson

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spinal Deformity ◽

Pediatric Patients ◽

Site Infection ◽

Factors Associated ◽

Spinal Deformity Surgery

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Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?

Spine Deformity ◽

10.1007/s43390-020-00120-6 ◽

2020 ◽

Vol 8 (5) ◽

pp. 931-938

Author(s):

Connie Poe-Kochert ◽

Jilan L. Shimberg ◽

George H. Thompson ◽

Jochen P. Son-Hing ◽

Christina K. Hardesty ◽

...

Keyword(s):

Surgical Site Infection ◽

Spinal Deformity ◽

Infection Prevention ◽

Site Infection ◽

Spinal Deformity Surgery ◽

Prevention Protocol

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Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

Global Spine Journal ◽

10.1177/2192568220937473 ◽

2020 ◽

Vol 10 (7) ◽

pp. 896-907

Author(s):

Eric O. Klineberg ◽

Peter G. Passias ◽

Gregory W. Poorman ◽

Cyrus M. Jalai ◽

Abiola Atanda ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Spinal Deformity ◽

Surgical Outcomes ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Estimated Blood Loss ◽

Patient Reported ◽

The Impact

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

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Excess Length of Stay Attributable to Surgical Site Infection Following Hip Replacement: A Nested Case-Control Study

Infection Control and Hospital Epidemiology ◽

10.1086/509828 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1299-1303 ◽

Cited By ~ 43

Author(s):

Vicente Monge Jodra ◽

Lourdes Sainz de los Terreros Soler ◽

Cristina Díaz-Agero Pérez ◽

Carmen María Saa Requejo ◽

Nieves Plana Farrás

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Hospital Stay ◽

Hip Replacement ◽

Case Control Study ◽

Case Control ◽

Site Infection ◽

Nested Case Control ◽

The Impact ◽

Control Study

Objective. We estimated the impact of hip replacement-associated surgical site infection (SSI) on morbidity and length of stay. Methods. This was a pairwise matched (1 : 1) case-control study nested in a cohort. All patients who underwent hip replacement from January 1, 2000, to June 30, 2004, were prospectively enrolled for the nested case-control design analysis and were monitored from the time of surgery until hospital discharge, including any patients readmitted because of infection. Results. Among the 1,260 hip replacements performed, 28 SSIs were detected, yielding a crude SSI rate of 2.2%. The median excess length of stay attributable to SSI was 32.5 days (P< .001), whereas the median prolonged postoperative stay due to SSI was 31 days (P< .001). Deep-wound SSI was the type that prolonged hospital stay the most (up to 49 days). Of the patients who developed an SSI, 4 required revision surgery, for an SSI-related morbidity rate of 14.3%. Conclusion. SSI prolongs hospital stay; however, although hospital stay is a rough indicator of the cost of this complication, to accurately estimate the costs of SSI, we would need to consider individual costs in a linear regression model adjusted for all possible confounding factors.

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