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

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.

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

Scientific Reports ◽

10.1038/s41598-021-87110-4 ◽

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.

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

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9766 ◽

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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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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Assessment of risk factors for surgical site infection following caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194886 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4518

Author(s):

Aditi Sangwan ◽

Vani Malhotra

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infection ◽

Site Infection ◽

Emergency Caesarean ◽

Group I ◽

Number Of Patients ◽

Duration Of Surgery ◽

Wound Discharge ◽

Group Ii

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus. Mean duration of resuturing was 17.42±6.98 days. Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.

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