scholarly journals The Association of Intraoperative Antibiotic and Surgical Site Infection After Lumbar Spine Surgery: Analysis of the Michigan Spine Surgery Improvement Collaborative

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Karam P Asmaro ◽  
Tarek R Mansour ◽  
Rachel J Hunt ◽  
Theresa A Elder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Antibiotic Prophylaxis ◽  
Spine Surgery ◽  
Private Insurance ◽  
Surgical Site Infections ◽  
Antibiotic Usage ◽  
Lumbar Spine Surgery ◽  
Perioperative Antibiotics ◽  
Vancomycin Powder

Abstract INTRODUCTION Surgical site infections (SSI) after lumbar spine surgery is costly and potentially preventable. A number of studies have shown the efficacy of vancomycin powder in preventing SSI, but there are few studies that have examined all the available perioperative antibiotics. We sought to examine associations between intraoperative antibiotic usage and SSI rates after lumbar spine surgery, as well as other risk factors for SSI, using a large prospective database. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a large multi-institute collaborative. MSSIC was queried to test the association between intraoperative antibiotic irrigation (bacitracin, cefazolin, vancomycin, etc), intraoperative vancomycin powder only, a combination of the two, and postoperative antibiotics with SSI using generalized estimating equations (GEE) models; variables included: age, gender, BMI, diabetes, heart disease, scoliosis, previous spine surgery, preoperative ambulatory status, insurance type (public vs private), surgery type (fusion vs decompression alone), and number of surgical levels. RESULTS A total of 24 229 patients undergoing lumbar spine surgery were included in the multivariate analysis. Postoperative antibiotic prophylaxis did not affect SSI (OR 1.00, P = .987). Preoperative antibiotics were universally given, and further analysis of intraoperative antibiotic usage was done. All comparisons were done to no additional antibiotics used; using only intraoperative vancomycin powder was associated with lower SSI (OR 0.77, P = .286). Using antibiotic irrigation only was associated with a significantly higher rate of SSI (OR1 .42, P = .009). Using a combination intraoperative vancomycin and irrigation was again associated with higher SSI (OR 1.28, P = .127), but not as high as irrigation alone. Protective factors for SSI include independently ambulation (OR 0.80, P = .015) and private insurance (OR 0.74, P = .001). Risk factors for SSI include BMI (OR 1.33, P < .001), diabetes (OR 1.36, P < .001), fusion (OR 1.41, P = .001), and increasing surgical levels (OR 1.59, P = .006). CONCLUSION The use of postoperative antibiotic prophylaxis was not associated with SSI. Intraoperative antibiotic irrigation may be less effective than realized, and the use of intraoperative vancomycin powder alone may be effective in preventing SSI. The efficacy of intraoperative antibiotic irrigation in preventing infection requires further investigation. Other risk factors for SSI are confirmed.

Incidence and Risk Factors for Postoperative Delirium After Lumbar Spine Surgery

Spine ◽  
2013 ◽  
Vol 38 (20) ◽  
pp. 1790-1796 ◽  
Author(s):  
Steven J. Fineberg ◽  
Sreeharsha V. Nandyala ◽  
Alejandro Marquez-Lara ◽  
Matthew Oglesby ◽  
Alpesh A. Patel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Postoperative Delirium ◽  
Lumbar Spine Surgery

The Effect of Vancomycin Powder on the Rates of Infection and Pseudarthrosis in Lumbar Spine Surgery: A Retrospective Analysis of 453 Patients

2016 ◽  
Vol 16 (10) ◽  
pp. S273
Author(s):  
Sukanta Maitra ◽  
Jordan Kump ◽  
Zach Lee ◽  
Yue Zhang ◽  
Stephen Pehler ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Retrospective Analysis ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Vancomycin Powder

Postoperative Visual Loss Following Lumbar Spine Surgery: A Review of Risk Factors by Diagnosis

2015 ◽  
Vol 84 (6) ◽  
pp. 2010-2021 ◽  
Author(s):  
Amy Li ◽  
Christian Swinney ◽  
Anand Veeravagu ◽  
Inderpreet Bhatti ◽  
John Ratliff
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Visual Loss ◽  
Lumbar Spine Surgery ◽  
Postoperative Visual Loss

Risk factors for delayed extubation in thoracic and lumbar spine surgery: a retrospective analysis of 135 patients

2013 ◽  
Vol 28 (2) ◽  
pp. 161-166 ◽  
Author(s):  
Fenghua Li ◽  
Reza Gorji ◽  
Richard Tallarico ◽  
Charles Dodds ◽  
Katharina Modes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Retrospective Analysis ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Thoracic And Lumbar Spine ◽  
Delayed Extubation

scholarly journals Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients

2021 ◽  
Vol 34 (1) ◽  
pp. 89-95
Author(s):  
Marcel R. Wiley ◽  
Leah Y. Carreon ◽  
Mladen Djurasovic ◽  
Steven D. Glassman ◽  
Yehia H. Khalil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Emergency Room ◽  
Spine Surgery ◽  
Administrative Databases ◽  
Lumbar Spine Surgery ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Single Center ◽  
Patient Counseling

OBJECTIVEIn the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery.METHODSA prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions.RESULTSOf 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million.CONCLUSIONSRisk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.

P88 Identifying risk factors for multiple revisional lumbar spine surgery

2019 ◽  
Vol 90 (3) ◽  
pp. e45.1-e45
Author(s):  
M El Sheikh ◽  
K Badran ◽  
O Kouli ◽  
M Abdelsadg ◽  
M Fadelalla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Morbidity Rate ◽  
Lumbar Spine Surgery ◽  
Neurosurgical Department ◽  
Primary Surgery ◽  
Diabetes Status

ObjectivesRecurrent lumbar spine surgery due to disc herniation is a contributor to debilitating pain, disability, and carries a high patient morbidity rate1 We identified risk factors for recurrent lumbar disc herniation post-surgical intervention.DesignRetrospective Cohort Study.SubjectsAll adult lumbar spine revisions for disc herniation performed in the Neurosurgical Department at Ninewells Hospital.MethodsThe number of revisions from 2013 to 2017 for each patient was recorded and two groups were identified. The first group consisted of patients who had one revision and the second group consisted of patients who had recurrent revisions (more than one) Possible factors influencing the likelihood of recurrent revisions were also noted, including age, gender, BMI, operation length, level of surgery, time from primary surgery to revision, smoking and diabetes status.Results140 patients had revision surgeries, of which 87 (62.1%) had one revision while 53 (37.1%) had recurrent operations. Younger patients (p=0.025) and patients with higher BMI (p=0.01) were more likely to have a higher number of revisions. Patients with DM (p=0.015) were associated with a higher likelihood of recurrent revisions. Other factors had little effect on the likelihood of recurrent revisions (p>0.05).ConclusionsIdentifying risk factors that influence the recurrence of lumbar revisions helps improve patient outcome and decrease incidence of revisions.

scholarly journals Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors

2017 ◽  
Vol 11 (5) ◽  
pp. 793-803 ◽  
Author(s):  
Yukitaka Nagamoto ◽  
Shota Takenaka ◽  
Hiroyuki Aono
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Confidence Interval ◽  
Spine Surgery ◽  
Odds Ratio ◽  
Protective Factor ◽  
Multivariate Logistic Regression Analysis ◽  
Lumbar Spine Surgery ◽  
Decompression Surgery ◽  
Mr Images

<sec><title>Study Design</title><p>Retrospective case–control study</p></sec><sec><title>Purpose</title><p>To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery.</p></sec><sec><title>Overview of Literature</title><p>Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery.</p></sec><sec><title>Methods</title><p>We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis.</p></sec><sec><title>Results</title><p>Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; <italic>p</italic>&lt;0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; <italic>p</italic>=0.002).</p></sec><sec><title>Conclusions</title><p>The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.</p></sec>

scholarly journals The risk factors associated with delirium after lumbar spine surgery in elderly patients

2019 ◽  
Vol 9 (4) ◽  
pp. 700-710 ◽  
Author(s):  
Zhimin Pan ◽  
◽  
Kai Huang ◽  
Wei Huang ◽  
Ki Hoon Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Elderly Patients ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Factors Associated ◽  
Surgery In Elderly
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