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

Medicine ◽  
2016 ◽  
Vol 95 (43) ◽  
pp. e5118 ◽  
Author(s):  
Hiroyuki Tominaga ◽  
Takao Setoguchi ◽  
Hideki Kawamura ◽  
Ichiro Kawamura ◽  
Satoshi Nagano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Site Infection

scholarly journals Risk factors for deep surgical site infection following thoracolumbar spinal surgery

2020 ◽  
Vol 32 (2) ◽  
pp. 292-301 ◽  
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.

Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation

2010 ◽  
Vol 12 (5) ◽  
pp. 540-546 ◽  
Author(s):  
Masahiko Watanabe ◽  
Daisuke Sakai ◽  
Daisuke Matsuyama ◽  
Yukihiro Yamamoto ◽  
Masato Sato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Patient Characteristics ◽  
Site Infection ◽  
The Mean ◽  
Preoperative Hospital Stay ◽  
Duration Of Operation

Object The purpose of this study was to identify risk factors for surgical site infection after spine surgery, noting the amount of saline used for intraoperative irrigation to minimize wound contamination. Methods The authors studied 223 consecutive spine operations from January 2006 through December 2006 at our institute. For a case to meet inclusion criteria as a site infection, it needed to require surgical incision and drainage and show positive intraoperative cultures. Preoperative and intraoperative data regarding each patient were collected. Patient characteristics recorded included age, sex, and body mass index (BMI). Preoperative risk factors included preoperative hospital stay, history of smoking, presence of diabetes, and an operation for a traumatized spine. Intraoperative factors that might have been risk factors for infection were collected and analyzed; these included type of procedure, estimated blood loss, duration of operation, and mean amount of saline used for irrigation per hour. Data were subjected to univariate and multivariate logistic regression analyses. Results The incidence of surgical site infection in this population was 6.3%. According to the univariate analysis, there was a significant difference in the mean duration of operation and intraoperative blood loss, but not in patient age, BMI, or preoperative hospital stay. The mean amount of saline used for irrigation in the infected group was less than in the noninfected group, but was not significantly different. In the multivariate analysis, sex, advanced age (> 60 years), smoking history, and obesity (BMI > 25 kg/m2) did not show significant differences. In the analysis of patient characteristics, only diabetes (patients receiving any medications or insulin therapy at the time of surgery) was independently associated with an increased risk of surgical site infection (OR 4.88). In the comparison of trauma and elective surgery, trauma showed a significant association with surgical site infection (OR 9.42). In the analysis of surgical factors, a sufficient amount of saline for irrigation (mean > 2000 ml/hour) showed a strong association with the prevention of surgical site infection (OR 0.08), but prolonged operation time (> 3 hours), high blood loss (> 300 g), and instrumentation were not associated with surgical site infection. Conclusions Diabetes, trauma, and insufficient intraoperative irrigation of the surgical wound were independent and direct risk factors for surgical site infection following spine surgery. To prevent surgical site infection in spine surgery, it is important to control the perioperative serum glucose levels in patients with diabetes, avoid any delay of surgery in patients with trauma, and decrease intraoperative contamination by irrigating > 2000 ml/hour of saline in all patients.

scholarly journals Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery: a consecutive series

2018 ◽  
Vol 29 (5) ◽  
pp. 549-552 ◽  
Author(s):  
David J. Salvetti ◽  
Zachary J. Tempel ◽  
Ezequiel Goldschmidt ◽  
Nicole A. Colwell ◽  
Federico Angriman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Status ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Nutritional Deficiency ◽  
Serum Biomarker ◽  
Nutritional Deficiencies ◽  
Consecutive Series ◽  
Site Infection ◽  
Preoperative Serum

OBJECTIVENutritional deficiency negatively affects outcomes in many health conditions. In spine surgery, evidence linking preoperative nutritional deficiency to postoperative surgical site infection (SSI) has been limited to small retrospective studies. Authors of the current study analyzed a large consecutive cohort of patients who had undergone elective spine surgery to determine the relationship between a serum biomarker of nutritional status (preoperative prealbumin levels) and SSI.METHODSThe authors conducted a retrospective review of the electronic medical charts of patients who had undergone posterior spinal surgeries and whose preoperative prealbumin level was available. Additional data pertinent to the risk of SSI were also collected. Patients who developed a postoperative SSI were identified, and risk factors for postoperative SSI were analyzed. Nutritional deficiency was defined as a preoperative serum prealbumin level ≤ 20 mg/dl.RESULTSAmong a consecutive series of 387 patients who met the study criteria for inclusion, the infection rate for those with preoperative prealbumin ≤ 20 mg/dl was 17.8% (13/73), versus 4.8% (15/314) for those with preoperative prealbumin > 20 mg/dl. On univariate and multivariate analysis a low preoperative prealbumin level was a risk factor for postoperative SSI with a crude OR of 4.29 (p < 0.01) and an adjusted OR of 3.28 (p = 0.02). In addition, several previously known risk factors for infection, including diabetes, spinal fusion, and number of operative levels, were significant for the development of an SSI.CONCLUSIONSIn this consecutive series, preoperative prealbumin levels, a serum biomarker of nutritional status, correlated with the risk of SSI in elective spine surgery. Prehabilitation before spine surgery, including strategies to improve nutritional status in patients with nutritional deficiencies, may increase value and improve spine care.

scholarly journals Surgical Site Infection in Spine Surgery: Who Is at Risk?

2018 ◽  
Vol 8 (4_suppl) ◽  
pp. 5S-30S ◽  
Author(s):  
Reina Yao ◽  
Hanbing Zhou ◽  
Theodore J. Choma ◽  
Brian K. Kwon ◽  
John Street
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Subcutaneous Fat ◽  
Case Series ◽  
Preoperative Radiation ◽  
Site Infection ◽  
Postoperative Blood Transfusion ◽  
Duration Of Surgery

Study Design: Retrospective literature review of spine surgical site infection (SSI). Objective: To perform a review of SSI risk factors and more specifically, categorize them into patient and surgical factors. Methods: A review of published literature on SSI risk factors in adult spine surgery was performed. We included studies that reported risk factors for SSI in adult spinal surgery. Excluded are pediatric patient populations, systematic reviews, and meta-analyses. Overall, we identified 72 cohort studies, 1 controlled-cohort study, 1 matched-cohort study, 1 matched-paired cohort study, 12 case-controlled studies (CCS), 6 case series, and 1 cross-sectional study. Results: Patient-associated risk factors—diabetes mellitus, obesity (body mass index >35 kg/m2), subcutaneous fat thickness, multiple medical comorbidities, current smoker, and malnutrition were associated with SSI. Surgical associated factors—preoperative radiation/postoperative blood transfusion, combined anterior/posterior approach, surgical invasiveness, or levels of instrumentation were associated with increased SSI. There is mixed evidence of age, duration of surgery, surgical team, intraoperative blood loss, dural tear, and urinary tract infection/urinary catheter in association with SSI. Conclusion: SSIs are associated with many risk factors that can be patient or surgically related. Our review was able to identify important modifiable and nonmodifiable risk factors that can be essential in surgical planning and discussion with patients.

scholarly journals Risk factors for deep surgical site infection after posterior cervical spine surgery in adults: a multicentre observational cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Satoshi Ogihara ◽  
Takashi Yamazaki ◽  
Michio Shiibashi ◽  
Hirotaka Chikuda ◽  
Toru Maruyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cervical Spine ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Observational Cohort Study ◽  
Adult Patients ◽  
Site Infection ◽  
Cervical Spine Surgery ◽  
Observational Cohort

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.

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

2016 ◽  
Vol 16 (4) ◽  
pp. 504-509 ◽  
Author(s):  
Arjun Sebastian ◽  
Paul Huddleston ◽  
Sanjeev Kakar ◽  
Elizabeth Habermann ◽  
Amy Wagie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Site Infection ◽  
Cervical Spine Surgery ◽  
Acs Nsqip

Predictors and Risk Factors of Surgical Site Infection (SSI) Following Adult Spine Surgery: A Cross-sectional Study

2021 ◽  
pp. 6
Author(s):  
Waleed Awwad ◽  
Abdullah Alnasser ◽  
Abdulrahman Almalki ◽  
Rohail Mumtaz ◽  
Bander Alsubaie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Length Of Hospital Stay ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Sectional Study ◽  
Cross Sectional ◽  
Duration Of Surgery

Introduction: Surgical site infection (SSI) is a major cause of morbidity and mortality as it is known to increase the length of hospital stay, revision surgery, and re-operation. Identifying patients at risk of developing SSI before surgery is the key to prevent SSI. Methodology: This cross-sectional study was performed at the orthopedic department in King Khalid University Hospital, Riyadh, Saudi Arabia. SSIs were defined according to the Centers for Disease Control (CDC) case definition for SSI. Potential risk factors for postoperative wound infection were collected. Data were analyzed using the SPSS, version 23.0, and p-value < 0.05 was considered to be statistically significant. Result: A total of 214 patients were included in the study and the incidence of SSI following spine surgery was 9.81% (N = 21). Obesity, diabetes, location of surgery, ASA score, duration of surgery, length of hospital stay, and location/level of operated vertebrae were all found to have a significant correlation with the SSI (p < 0.05). Conclusion: Having a strong background of SSI risk factors and predictors is core to preventing the incidence of SSI and further enhance and optimize operative outcomes, as well as increasing the cost-effectiveness of the surgical intervention.

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