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

2018 ◽  
Vol 29 (6) ◽  
pp. 628-634 ◽  
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.

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

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

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.

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.

scholarly journals Surgical Site Infection Prevention Following Spine Surgery

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 92S-98S ◽  
Author(s):  
Ilyas S. Aleem ◽  
Lee A. Tan ◽  
Ahmad Nassr ◽  
K. Daniel Riew
Keyword(s):  
Literature Review ◽  
Surgical Site Infection ◽  
Spine Surgery ◽  
Antimicrobial Prophylaxis ◽  
Tight Glycemic Control ◽  
Site Infection ◽  
Skin Preparation ◽  
Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Posterior Cervical Surgery

Study Design: Literature review. Objectives: Surgical site infection (SSI) following spine surgery leads to significant patient morbidity, mortality, and increased health care costs. The purpose of this article is to identify risk factors and strategies to prevent SSIs following spine surgery, with particular focus on avoiding infections in posterior cervical surgery. Methods: We performed a literature review and synthesis to identify methods that can be used to prevent the development of SSI following spine surgery. Specific pearls for preventing infection in posterior cervical spine surgery are also presented. Results: SSI prevention can be divided into patient and surgeon factors. Preoperative patient factors include smoking cessation, tight glycemic control, weight loss, and nutrition optimization. Surgeon factors include screening and treatment for pathologic microorganisms, skin preparation using chlorhexidine and alcohol, antimicrobial prophylaxis, hand hygiene, meticulous surgical technique, frequent irrigation, intrawound vancomycin powder, meticulous multilayered closure, and use of closed suction drains. Conclusion: Prevention of SSI following spine surgery is multifactorial and begins with careful patient selection, preoperative optimization, and meticulous attention to numerous surgical factors. With careful attention to various patient and surgeon factors, it is possible to significantly reduce SSI rates following spine surgery.

scholarly journals Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 124
Author(s):  
Giovanni Miccoli ◽  
Emanuele La Corte ◽  
Ernesto Pasquini ◽  
Giorgio Palandri
Keyword(s):  
Cervical Spine ◽  
Airway Obstruction ◽  
Operating Room ◽  
Spine Surgery ◽  
Superior Thyroid Artery ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Acute Airway Obstruction ◽  
Life Threatening ◽  
The Right

Background: One of the most serious and potentially life-threatening adverse events associated with anterior cervical spine surgery is postoperative hematoma with acute airway obstruction. The causes of unpredicted delayed bleeding are, however, not fully elucidated. Here, we report a case of delayed arterial bleeding and sudden airway obstruction following a two-level ACDF. Case Description: A 52-year-old male presented with the right paracentral disc herniations at the C4–C5 and C5–C6 levels. A two-level ACDF was performed. Notably, on the 5th postoperative day, the patient developed an acute respiratory distress due to a large right lateral retrotracheal hematoma requiring emergency evacuation at the bedside. This was followed by formal ligation of a branch of the right superior thyroid artery in the operating room. In addition, an emergency tracheotomy was performed. By postoperative day 15, the tracheotomy was removed, and the patient was neurologically intact. Conclusion: A superior thyroid artery hemorrhage should be suspected if a patient develops delayed neck swelling with or without respiratory decompensation several days to weeks following an ACDF. Notably, these hematomas should be immediately recognized and treated (i.e., decompression starting at the bedside and completed in the operating room) to prevent catastrophic morbidity or mortality.

Risk factor analysis and severity assessment of wound hematoma after anterior cervical spine surgery: A retrospective study

2020 ◽  
Author(s):  
Kai Zhou ◽  
Zhengxue Quan ◽  
Zhongyuan He ◽  
Ke Tang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Cervical Disc ◽  
Multivariate Logistic Regression ◽  
Cervical Spine Surgery ◽  
Hematoma Formation ◽  
Anterior Cervical Spine Surgery ◽  
History Of

Abstract Background We aim to explore the risk factors independently associated with postoperative wound hematoma in patients who have undergone anterior cervical spine surgery. Methods The clinical data of patients with cervical spondylosis or cervical disc herniation who underwent anterior cervical spine surgery by the senior author from January 2011 to December 2017 were evaluated. Multivariate logistic regression was conducted to compare the hematoma group and the no-hematoma group to determine which factors were independently associated with hematoma formation in patients who need evacuation. The Mann-Whitney U test was conducted to compare the Neck Disability Index score in the two groups. Results A total of 678 patients met the criteria and underwent anterior cervical spine surgery. Thirteen patients undergone hematoma evacuation. Multivariate logistic regression analysis identified that history of hypertension (p = 0.039 OR = 4.42 95% CI 1.08–18.07) and therapeutic heparin use (p = 0.020 OR = 4.58 95% CI 1.27–16.59) were independent risk factors for hematoma formation. The t-test showed no significant differences between the hematoma group and the no-hematoma group in terms of APTT or PT levels (p > 0.05). The Mann-Whitney U test indicated that there was no difference in NDI scores between the two groups(p > 0.05). Conclusion History of hypertension and therapeutic heparin use are risk factors for hematoma formation. Meticulous hemostasis, moderate muscle subtraction, and perioperative airway management are critical for avoiding hematoma development. The Neck Hematoma Scores can quickly determine the severity of a hematoma in the absence of radiographic image evidence.

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