Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005–2012

AbstractSurgical site infection (SSI) is a serious complication following spine surgery and is correlated with significant morbidities, poor clinical outcomes, and increased healthcare costs. Accurately identifying risk factors can help develop strategies to reduce this devastating consequence; however, few multicentre studies have investigated risk factors for SSI following posterior cervical spine surgeries. Between July 2010 and June 2015, we performed an observational cohort study on deep SSI in adult patients who underwent posterior cervical spine surgery at 10 research hospitals. Detailed patient- and procedure-specific potential risk variables were prospectively recorded using a standardised data collection chart and were reviewed retrospectively. Among the 2184 consecutive adult patients enrolled, 28 (1.3%) developed postoperative deep SSI. Multivariable regression analysis revealed 2 statistically significant independent risk factors: occipitocervical surgery (P < 0.001) and male sex (P = 0.024). Subgroup analysis demonstrated that occipitocervical surgery (P = 0.001) was the sole independent risk factor for deep SSI in patients with instrumented fusion. Occipitocervical surgery is a relatively rare procedure; therefore, our findings were based on a large cohort acquired using a multicentre study. To the best of our knowledge, this is the first study to identify occipitocervical procedure as an independent risk variable for deep SSI after spinal surgery.

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The risk factors of surgical site infection following posterior cervical spine surgery

10.21203/rs.3.rs-331817/v1 ◽

2021 ◽

Author(s):

Yvang Chang ◽

Ming Yang ◽

Wentao Zhang ◽

Gang Xu ◽

Zhonghai Li

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cervical Spine ◽

Serum Albumin ◽

Surgical Site Infection ◽

Spine Surgery ◽

Patient Specific ◽

Site Infection ◽

Cervical Spine Surgery ◽

Preoperative Serum

Abstract Background: Surgical site infection (SSI) is a common complication following posterior cervical spine surgery, imposing a high burden on patients and society. However, information about its characteristics and related risk factors is limited. We designed this study intended to address this issue.Methods: From January 2011 through October 2020, a total of 405 patients diagnosed of cervical degenerative diseases (cervical spondylotic myelopathy, ossification of posterior longitudinal ligament and cervical disk herniation) who were treated with unilateral open-door lamnioplasty surgeries were enrolled in this study. We divided the patients into the SSI group and the non-SSI group and compared their patient-specific and procedure-specific factors. Univariate and multiple logistic regression analyses were performed to determine risk factors. Results: There were significant differences between groups in subcutaneous fat thickness (FT) (P<0.001), ratio of subcutaneous FT to muscle thickness (MT) (P<0.001), preoperative Japanese Orthopaedic Association（JOA）Scores (P< 0.003), preoperative serum albumin (P< 0.001), postoperative drainage (P<0.004), time of draining (P<0.001). Logistic regression analysis of these differences showed that ratio of subcutaneous FT/MT, preoperative JOA score, preoperative serum albumin and longer time of draining were significantly related to SSI (P<0.05).Conclusion: Ratio of subcutaneous FT/MT, preoperative JOA score, preoperative serum albumin and longer time of draining are identified as the independent risk factors of SSI in posterior cervical spine surgeries. Identification of these risk factors could be useful in reducing SSI incidence and patients counseling.

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The relationship between surgical site drains and reoperation for wound-related complications following posterior cervical spine surgery: a multicenter retrospective study

Journal of Neurosurgery Spine ◽

10.3171/2018.5.spine171313 ◽

2018 ◽

Vol 29 (6) ◽

pp. 628-634 ◽

Cited By ~ 5

Author(s):

Daniel B. Herrick ◽

Joseph E. Tanenbaum ◽

Marc Mankarious ◽

Sagar Vallabh ◽

Eitan Fleischman ◽

...

Keyword(s):

Cervical Spine ◽

Surgical Site Infection ◽

Operating Room ◽

Spine Surgery ◽

Site Infection ◽

Lower Odds ◽

Cervical Spine Surgery ◽

History Of ◽

Drain Placement ◽

The Relationship

OBJECTIVEUse of surgical site drains following posterior cervical spine surgery is variable, and its impact on outcomes remains controversial. Studies of drain use in the lumbar spine have suggested that drains are not associated with reduction of reoperations for wound infection or hematoma. There is a paucity of studies examining this relationship in the cervical spine, where hematomas and infections can have severe consequences. This study aims to examine the relationship between surgical site drains and reoperation for wound-related complications following posterior cervical spine surgery.METHODSThis study is a multicenter retrospective review of 1799 consecutive patients who underwent posterior cervical decompression with instrumentation at 4 tertiary care centers between 2004 and 2016. Demographic and perioperative data were analyzed for associations with drain placement and return to the operating room.RESULTSOf 1799 patients, 1180 (65.6%) had a drain placed. Multivariate logistic regression analysis identified history of diabetes (OR 1.37, p = 0.03) and total number of levels operated (OR 1.32, p < 0.001) as independent predictors of drain placement. Rates of reoperation for any surgical site complication were not different between the drain and no-drain groups (4.07% vs 3.88%, p = 0.85). Similarly, rates of reoperation for surgical site infection (1.61% vs 2.58%, p = 0.16) and hematoma (0.68% vs 0.48%, p = 0.62) were not different between the drain and no-drain groups. However, after adjusting for history of diabetes and the number of operative levels, patients with drains had significantly lower odds of returning to the operating room for surgical site infection (OR 0.48, p = 0.04) but not for hematoma (OR 1.22, p = 0.77).CONCLUSIONSThis large study characterizes current practice patterns in the utilization of surgical site drains during posterior cervical decompression and instrumentation. Patients with drains placed did not have lower odds of returning to the operating room for postoperative hematoma. However, the authors’ data suggest that patients with drains may be less likely to return to the operating room for surgical site infection, although the absolute number of infections in the entire population was small, limiting the analysis.

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Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery

Medicine ◽

10.1097/md.0000000000005118 ◽

2016 ◽

Vol 95 (43) ◽

pp. e5118 ◽

Cited By ~ 9

Author(s):

Hiroyuki Tominaga ◽

Takao Setoguchi ◽

Hideki Kawamura ◽

Ichiro Kawamura ◽

Satoshi Nagano ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spine Surgery ◽

Site Infection

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Answer to the Letter to the Editor of J. Huang et al. concerning “Risk factors for surgical site infection and urinary tract infection after spine surgery” by Tominaga H, Setoguchi T, Ishidou Y, Nagano S, Yamamoto T, and Komiya S (2016) Eur Spine J; DOI 10.1007/s00586-016-4674-2

European Spine Journal ◽

10.1007/s00586-016-4775-y ◽

2016 ◽

Vol 25 (11) ◽

pp. 3772-3772

Author(s):

Hiroyuki Tominaga

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Surgical Site Infection ◽

Spine Surgery ◽

Site Infection ◽

Letter To The Editor

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Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Journal of Neurosurgery Spine ◽

10.3171/2019.8.spine19479 ◽

2020 ◽

Vol 32 (2) ◽

pp. 292-301 ◽

Cited By ~ 5

Author(s):

Hansen Deng ◽

Andrew K. Chan ◽

Simon G. Ammanuel ◽

Alvin Y. Chan ◽

Taemin Oh ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spine Surgery ◽

Thoracolumbar Spine ◽

Hospital Length Of Stay ◽

Site Infection ◽

Asa Classification ◽

Estimated Blood Loss ◽

History Of ◽

The Mean

OBJECTIVESurgical site infection (SSI) following spine surgery causes major morbidity and greatly impedes functional recovery. In the modern era of advanced operative techniques and improved perioperative care, SSI remains a problematic complication that may be reduced with institutional practices. The objectives of this study were to 1) characterize the SSI rate and microbial etiology following spine surgery for various thoracolumbar diseases, and 2) identify risk factors that were associated with SSI despite current perioperative management.METHODSAll patients treated with thoracic or lumbar spine operations on the neurosurgery service at the University of California, San Francisco from April 2012 to April 2016 were formally reviewed for SSI using the National Healthcare Safety Network (NHSN) guidelines. Preoperative risk variables included age, sex, BMI, smoking, diabetes mellitus (DM), coronary artery disease (CAD), ambulatory status, history of malignancy, use of preoperative chlorhexidine gluconate (CHG) showers, and the American Society of Anesthesiologists (ASA) classification. Operative variables included surgical pathology, resident involvement, spine level and surgical technique, instrumentation, antibiotic and steroid use, estimated blood loss (EBL), and operative time. Multivariable logistic regression was used to evaluate predictors for SSI. Odds ratios and 95% confidence intervals were reported.RESULTSIn total, 2252 consecutive patients underwent thoracolumbar spine surgery. The mean patient age was 58.6 ± 13.8 years and 49.6% were male. The mean hospital length of stay was 6.6 ± 7.4 days. Sixty percent of patients had degenerative conditions, and 51.9% underwent fusions. Sixty percent of patients utilized presurgery CHG showers. The mean operative duration was 3.7 ± 2 hours, and the mean EBL was 467 ± 829 ml. Compared to nonfusion patients, fusion patients were older (mean 60.1 ± 12.7 vs 57.1 ± 14.7 years, p < 0.001), were more likely to have an ASA classification > II (48.0% vs 36.0%, p < 0.001), and experienced longer operative times (252.3 ± 120.9 minutes vs 191.1 ± 110.2 minutes, p < 0.001). Eleven patients had deep SSI (0.49%), and the most common causative organisms were methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus. Patients with CAD (p = 0.003) or DM (p = 0.050), and those who were male (p = 0.006), were predictors of increased odds of SSI, and presurgery CHG showers (p = 0.001) were associated with decreased odds of SSI.CONCLUSIONSThis institutional experience over a 4-year period revealed that the overall rate of SSI by the NHSN criteria was low at 0.49% following thoracolumbar surgery. This was attributable to the implementation of presurgery optimization, and intraoperative and postoperative measures to prevent SSI across the authors’ institution. Despite prevention measures, having a history of CAD or DM, and being male, were risk factors associated with increased SSI, and presurgery CHG shower utilization decreased SSI risk in patients.

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Orthostatic Hypotension Following Cervical Spine Surgery: Prevalence and Risk Factors

Global Spine Journal ◽

10.1177/2192568219863805 ◽

2019 ◽

Vol 10 (5) ◽

pp. 578-582

Author(s):

Edward Tien-En Ong ◽

Lincoln Kai-Pheng Yeo ◽

Arun-Kumar Kaliya-Perumal ◽

Jacob Yoong-Leong Oh

Keyword(s):

Risk Factors ◽

Cervical Spine ◽

Orthostatic Hypotension ◽

Functional Status ◽

Spine Surgery ◽

Surgical Approach ◽

Mechanism Of Injury ◽

Medical Comorbidities ◽

Cervical Spine Surgery ◽

Cord Injury

Study Design: Retrospective case series. Objectives: This study aims to determine the prevalence and risk factors for orthostatic hypotension (OH) in patients undergoing cervical spine surgery. Methods: Data was collected from records of 190 consecutive patients who underwent cervical spine procedures at our center over 24 months. Statistical comparison was made between patients who developed postoperative OH and those who did not by analyzing characteristics such as age, gender, premorbid medical comorbidities, functional status, mechanism of spinal cord injury, preoperative neurological function, surgical approach, estimated blood loss, and length of stay. Results: Twenty-two of 190 patients (11.6%) developed OH postoperatively. No significant differences in age, gender, medical comorbidities, or premorbid functional status were observed. Based on univariate comparisons, traumatic mechanism of injury ( P = .002), poor ASIA (American Spinal Injury Association) grades (A, B, or C) ( P < .001), and posterior surgical approach ( P = .045) were found to significantly influence occurrence of OH. Among the significant variables, after adjusting for mechanism of injury and surgical approach, only ASIA grade was found to be an independent predictor. Having an ASIA grade of A, B, or C increased the likelihood of developing OH by approximately 5.978 times ( P = .003). Conclusion: Our study highlights that OH is not an uncommon manifestation following cervical spine surgery. Patients with poorer ASIA grades A, B, or C were more likely to have OH when compared with those with ASIA grades D or E (43.5% vs 7.2%). Hence, we suggest that postural blood pressure should be routinely monitored in this group of patients so that early intervention can be initiated.

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