Use of an intraoperative sodium oxychlorosene–based infection prevention protocol to safely decrease postoperative wound infections after spine surgery

2021 ◽  
pp. 1-7
Author(s):  
Vincent J. Alentado ◽  
Robert P. Berwanger ◽  
Anabel M. Konesco ◽  
Alex J. Potts ◽  
Caroline A. Potts ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Wound Infection ◽  
Spine Surgery ◽  
Postoperative Infection ◽  
Infection Prevention ◽  
Protocol Implementation ◽  
Postoperative Wound ◽  
Deep Wound ◽  
Prevention Protocol

OBJECTIVE Postoperative infection remains prevalent after spinal surgical procedures. Institutional protocols for infection prevention have improved rates of infection after spine surgery. However, prior studies have focused on only elective surgical patients. The aim of this study was to determine the efficacy of a multiinstitutional intraoperative sodium oxychlorosene–based infection prevention protocol for decreasing rate of infection after instrumented spinal surgery. METHODS A retrospective analysis was performed at two tertiary care institutions with level I trauma programs, and patients who underwent posterior instrumented spinal fusion between January 1, 2011, and May 31, 2019, were included. Postoperative deep wound infection rates were captured before and after implementation of a multiinstitutional infection prevention protocol. Possible adverse outcomes related to infection prevention techniques were also examined. In addition, consecutive patients treated from January 1, 2018, to May 31, 2019, were prospectively included in a database to collect preoperative and postoperative spine-specific quality of life measures and to assess the impact of postoperative infection on quality of life. RESULTS A total of 5047 patients fit the inclusion criteria. Of these, 1043 patients underwent surgery prior to protocol implementation. The infection rate of this cohort (3.5%) decreased significantly after protocol implementation (1.2%, p < 0.001). Postoperative sterile seroma rates did not differ between the preprotocol and postprotocol groups (0.7% vs 0.7%, p = 0.5). In the 1031 patients who underwent surgery between January 2018 and May 2019, the fusion rate was 89.2%. Quality of life outcomes between patients with infection and those without infection were similar, although statistical power was limited owing to the low rate of infection. Notably, 2 of 10 patients who developed deep wound infection died of infection-related complications. CONCLUSIONS An intraoperative sodium oxychlorosene–based infection prevention protocol helped to significantly decrease the rate of infection after spine surgery without negatively impacting other postoperative procedure-related metrics. Postoperative wound infection may be associated with higher-than-expected rate of postoperative mortality.

scholarly journals Efficacy of a Postoperative Infection Prevention Protocol in Spine Surgery

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582822-s-0036-1582822
Author(s):  
Samuel Pantoja ◽  
Felipe Luna ◽  
Beatrice Hervé ◽  
Cecilia Gutierrez ◽  
Roberto Postigo
Keyword(s):  
Spine Surgery ◽  
Postoperative Infection ◽  
Infection Prevention ◽  
Prevention Protocol

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

2021 ◽  
Author(s):  
Marcus Rickert ◽  
Michael Rauschmann ◽  
Nizar Latif-Richter ◽  
Mohammad Arabmotlagh ◽  
Tamin Rahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Negative Pressure Wound Therapy ◽  
Wound Infections ◽  
Wound Therapy ◽  
Postoperative Wound ◽  
Deep Wound ◽  
The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

Subjective and Objective Quality-of-Life Assessment of Outcome Measures in Cervical Spine Surgery for Degenerative Changes

2021 ◽  
Author(s):  
Marek Prokopienko ◽  
Michał Sobstyl
Keyword(s):  
Quality Of Life ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Treatment Options ◽  
Life Assessment ◽  
Quality Of Life Assessment ◽  
Surgical Strategies ◽  
Cervical Spine Surgery ◽  
Objective Quality

AbstractCervical spine diskectomy is a commonly used procedure in degenerative disease of cervical spine surgery. However, it is difficult to assess the quality of life after this widely applied and variously modified procedure. This literature review presents cervical diskectomy results, according to various scales and measures in multidirectional surgical strategies. Using relevant databases, we tried to find the best treatment options for degenerative disk disease and the best method of quality-of-life assessment, searching for modalities that may influence the outcome.

Biopsychosocial factors predict quality of life in thoracolumbar spine surgery

2017 ◽  
Vol 26 (11) ◽  
pp. 3099-3110 ◽  
Author(s):  
Dean A. Tripp ◽  
Edward Abraham ◽  
Maude Lambert ◽  
Kate Wagg ◽  
Erin Bigney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spine Surgery ◽  
Thoracolumbar Spine

Wide variation in risk of wound infection following clean neurosurgery

1985 ◽  
Vol 62 (2) ◽  
pp. 243-247 ◽  
Author(s):  
James H. Tenney ◽  
David Vlahov ◽  
Michael Salcman ◽  
Thomas B. Ducker
Keyword(s):  
Wound Infection ◽  
Wound Infection Rate ◽  
Neurosurgical Procedures ◽  
Postoperative Wound Infection ◽  
Content Type ◽  
Postoperative Wound ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Potential Efficacy ◽  
Perioperative Antibiotics

✓ The authors have prospectively examined the occurrence of postoperative wound infection following clean neurosurgery in 936 patients. Fewer than 1% received perioperative antibiotic prophylaxis. The overall rate of deep wound infection was 2.6%; no deaths were directly attributable to these infections. Deep wound infections occurred significantly more frequently following craniotomy (4.3%) than following spinal (0.9%) or other clean neurosurgery. Among craniotomies, the deep wound infection rate varied significantly from 11% following repeat operations for recurrent gliomas to 2.5% following non-tumor surgery. Risk of deep wound infection varied more than 11-fold depending on the type of clean neurosurgical operation. It is most feasible to demonstrate the potential efficacy of perioperative antibiotics in clean neurosurgical procedures with the greatest risk of postoperative wound infection. The potential benefit from such prophylaxis would be greatest for patients undergoing these high-risk operations.

Association of Modic changes with health-related quality of life among patients referred to spine surgery

2014 ◽  
Vol 5 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Juhani Määttä ◽  
Hannu Kautiainen ◽  
Ville Leinonen ◽  
Jaakko Niinimäki ◽  
Salme Järvenpää ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spine Surgery ◽  
Modic Changes ◽  
Type I ◽  
Type Ii ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Relationship

AbstractBackground and purposeModic changes (MC) are bone marrow and vertebral endplate lesions seen in magnetic resonance imaging (MRI) which have been found to be associated with low back pain (LBP), but the association between MC and health-related quality of life (HRQoL) is poorly understood. The aim of this study was to assess the relationship between MC and HRQoL among patients referred to spine surgery.MethodsThe study population consisted of 181 patients referred to lumbar spine surgery in Northern and Eastern Finland between June 2007 and January 2011. HRQoL was assessed using RAND-36 health survey. Lumbar MC were evaluated and classified into ‘No MC’, ‘Type I’ (Type I or I/II), and ‘Type II’ (Type II, II/III or III).ResultsIn total, 84 patients (46%) had MC. Of these, 37% had ‘Type I’ and 63% ‘Type II’. Patients with MC were older, more likely females, had longer duration of LBP and a higher degree of disc degeneration than patients without MC. The total physical component or physical dimensions did not differ significantly between the groups. The total mental component of RAND-36 (P = 0.010), and dimensions of energy (P = 0.023), emotional well-being (P = 0.012) and emotional role functioning (P = 0.016) differed significantly between the groups after adjustments for age and gender. In the mental dimension scores, a statistically significant difference was found between ‘No MC’ and ‘Type II’.ConclusionsAmong patients referred to spine surgery, MC were not associated with physical dimensions of HRQoL including dimension of pain. However, ‘Type II’ MC were associated with lower mental status of HRQoL.ImplicationsOur study would suggest that Type II MC were associated with a worse mental status. This may affect the outcome of surgery as it is well recognized that patients with depression, for instance, have smaller improvements in HRQoL and disability. Thus the value of operative treatment for these patients should be recognized and taken into consideration in treatment. Our study shows that MC may affect outcome and thus clinicians and researchers should be cognizant of this and take this into account when comparing outcomes of surgical treatment in the future. A longitudinal study would be needed to properly address the relationship of MC with surgical outcome.

Evaluating the Correlation and Responsiveness of Patient-Reported Pain With Function and Quality-of-Life Outcomes After Spine Surgery

Spine ◽  
2011 ◽  
Vol 36 ◽  
pp. S69-S74 ◽  
Author(s):  
John DeVine ◽  
Daniel C. Norvell ◽  
Erika Ecker ◽  
Daryl R. Fourney ◽  
Alex Vaccaro ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spine Surgery ◽  
Life Outcomes ◽  
Quality Of Life Outcomes ◽  
Patient Reported

scholarly journals Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Vincenzo De Luna ◽  
Federico Mancini ◽  
Fernando De Maio ◽  
Gabriele Bernardi ◽  
Ernesto Ippolito ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Wound Infection ◽  
Spine Surgery ◽  
Povidone Iodine ◽  
Site Infection ◽  
Iodine Solution ◽  
Deep Wound ◽  
Group A ◽  
Group B ◽  
Povidone Iodine Solution

Background. Deep wound infection in spine surgery is a debilitating complication for patients and increases costs. The objective of this prospective study was to evaluate the efficacy of wound pulse irrigation with a dilute povidone-iodine solution in the prevention of surgical site infection.Methods. 50 patients undergoing spinal surgery were randomly divided into two groups (A and B) of 25 patients each. In group A, wounds were irrigated with dilute (3%) povidone-iodine solution through a low-pressure pulsatile device. In group B, wounds were irrigated with saline solution through a bulb syringe. In both groups, specimens for bacterial culture were harvested from surgical site before and after irrigation.Results. In group A, no surgical site infection occurred; in group B, deep wound infection was observed in 3 patients. In both groups, before irrigation some cultures have been found positive for bacterial contamination.Conclusion. Our study seems to support the idea that low-pressure pulsating lavage of surgical wounds with povidone-iodine diluted to a nontoxic concentration of 3% is an effective therapeutic adjunct measure to prevent surgical site infection in spine surgery. However, the number of the enrolled patients is small and a significant statistical analysis is not practicable. This trial is registered withNCT03249363.

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