Risk factors of surgical site infections in instrumented spine surgery

Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs 52.8%, p = 0.87). The risk of complications was higher among patients submitted to spine instrumentation than those submitted to non-instrumented surgery (33% vs 22%), p=0.8. Conclusion : Just over one-quarter of patients in the sample developed complications. In this study, age, BMI, comorbidities were not associated with increased risk of complications after spine surgery. The use of instrumentation increased the absolute risk of complications.

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The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery

The Spine Journal ◽

10.1016/j.spinee.2019.05.592 ◽

2019 ◽

Vol 19 (10) ◽

pp. 1648-1656 ◽

Cited By ~ 7

Author(s):

Justin V.C. Lemans ◽

F. Cumhur Öner ◽

Sebastiaan P.J. Wijdicks ◽

Miquel B. Ekkelenkamp ◽

H. Charles Vogely ◽

...

Keyword(s):

Spine Surgery ◽

Povidone Iodine ◽

Surgical Site Infections ◽

Vancomycin Powder ◽

Instrumented Spine Surgery

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

Neurosurgery ◽

10.1093/neuros/nyz310_178 ◽

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.

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Risk Factors and Prevention of Surgical Site Infections Following Spinal Procedures

Global Spine Journal ◽

10.1177/2192568218806275 ◽

2018 ◽

Vol 8 (4_suppl) ◽

pp. 44S-48S ◽

Cited By ~ 6

Author(s):

Rani Nasser ◽

Jennifer A. Kosty ◽

Sanjit Shah ◽

Jeffrey Wang ◽

Joseph Cheng

Keyword(s):

Risk Factors ◽

Spine Surgery ◽

Wound Care ◽

Surgical Site Infections ◽

Perioperative Period ◽

Skin Preparation ◽

Cochrane Database ◽

Personnel Turnover ◽

Potential Risk Factors ◽

Meta Analyses

Study Design: Focused literature review. Objective: The objective of this article was to help identify potential risk factors as well as strategies to help prevent surgical site infections (SSIs) in spine surgery. Methods: An article search was performed using PubMed, EMBASE, and the Cochrane database of systematic reviews using the terms “surgery” OR “surgical” AND “spine” OR “spinal” AND “infection”. Systematic review articles, meta-analyses, and clinical trials with more than 100 patients were reviewed. Results: Both patient and perioperative factors contribute to the development of SSIs. Patient factors such as smoking, obesity, diabetes, Methicillin-resistant Staphylococcus aureus (MRSA) colonization, and malnutrition are all modifiable risk factors that can lead to SSIs. Procedural steps, including preoperative MRSA screening and treatment for colonization, preoperative antibiotics, skin preparation, minimizing operative time, antibiotic or betadine irrigation, avoiding personnel turnover, and postoperative wound care have also been shown to decrease infection rates. Conclusion: There are several measures a spine practitioner may be able to take in the preoperative, intraoperative, and postoperative settings. Protocols to counsel patients regarding modification of preexisting risk factors and ensure adequate antimicrobial therapy in the perioperative period may be developed to reduce SSIs in spine surgery.

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Intrawound Treatment for Prevention of Surgical Site Infections in Instrumented Spinal Surgery: A Systematic Comparative Effectiveness Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568218786252 ◽

2018 ◽

Vol 9 (2) ◽

pp. 219-230 ◽

Cited By ~ 8

Author(s):

Justin V. C. Lemans ◽

Sebastiaan P. J. Wijdicks ◽

Willemijn Boot ◽

Geertje A. M. Govaert ◽

R. Marijn Houwert ◽

...

Keyword(s):

Relative Risk ◽

Randomized Controlled Trials ◽

Spine Surgery ◽

Spinal Surgery ◽

Meta Analysis ◽

Surgical Site Infections ◽

Controlled Trials ◽

Local Antibiotics ◽

Randomized Controlled ◽

Instrumented Spine Surgery

Study Design: Systematic review and meta-analysis. Objectives: To determine the efficacy of intrawound treatments in reducing deep surgical site infections (SSIs) in instrumented spinal surgery. Methods: The electronic databases MEDLINE, EMBASE, and Cochrane were systematically searched for intrawound treatments for the prevention of SSIs in clean instrumented spine surgery. Both randomized controlled trials and comparative cohort studies were included. The results of included studies were pooled for meta-analysis. Results: After full text- and reference screening, 20 articles were included. There were 2 randomized controlled trials and 18 observational studies. Sixteen studies investigated the use of intrawound antibiotics, and 4 studies investigated the use of intrawound antiseptics. The relative risk of deep SSI for any treatment was 0.26 (95% confidence interval [CI] 0.16-0.44, P < .0001), a significant reduction compared with controls receiving no treatment. For patients treated with local antibiotics the relative risk was 0.29 (95% CI 0.17-0.51, P < .0001), and patients treated with local antiseptics had a relative risk of 0.14 (95% CI 0.05-0.44, P = .0006). Conclusions: Both the use of antibiotic and antiseptic intrawound prophylactics was associated with a significant 3 to 7 times reduction of deep SSIs in instrumented spine surgery. No adverse events were reported in the included studies.

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Risk Factors Associated With 30-day Readmissions After Instrumented Spine Surgery in 14,939 Patients

Spine ◽

10.1097/brs.0000000000000916 ◽

2015 ◽

Vol 40 (13) ◽

pp. 1022-1032 ◽

Cited By ~ 65

Author(s):

Paul T. Akins ◽

Jessica Harris ◽

Julie L. Alvarez ◽

Yuexin Chen ◽

Elizabeth W. Paxton ◽

...

Keyword(s):

Risk Factors ◽

Spine Surgery ◽

Factors Associated ◽

Instrumented Spine Surgery

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Surgical site infections in spine surgery focused literature review. Case report

Chirurgia Narządów Ruchu i Ortopedia Polska ◽

10.31139/chnriop.2020.85.5-6.5 ◽

2020 ◽

Vol 85 (5-6) ◽

pp. 116-120

Author(s):

Adam Sulewski ◽

◽

Mikołaj Dąbrowski ◽

Tomasz Andrzejewski ◽

Wojciech Łabędź ◽

...

Keyword(s):

Risk Factors ◽

Spine Surgery ◽

Clinical Case ◽

Negative Impact ◽

Treatment Plan ◽

Surgical Site Infections ◽

Clinical Results ◽

Patient Treatment ◽

Very High ◽

Original Treatment

Surgical site infections are a serious problem in spine surgery, they significantly extend the patient’s stay in the ward, are associated with very high costs of patient treatment, and also have a negative impact on the final clinical results and may modify the treatment plan. The article presents the current literature outline concerning the risk factors of perioperative infections in spine surgery and the procedure. A clinical case of a patient was described, where the infection led to misfortune of the original treatment plan and the possibility of obtaining only a partial clinical improvement in the patient.

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Antimicrobial prophylaxis in noninstrumented spine surgery: a prospective study to determine efficacy and drawbacks

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201891 ◽

2021 ◽

pp. 1-10

Author(s):

Aymeric Amelot ◽

Maximilien Riche ◽

Samuel Latreille ◽

Vincent Degos ◽

Alexandre Carpentier ◽

...

Keyword(s):

Risk Factors ◽

Single Dose ◽

Prospective Study ◽

Antibiotic Prophylaxis ◽

Spine Surgery ◽

Surgical Site Infections ◽

Csf Leak ◽

Resistant Bacteria ◽

Group A ◽

Group B

OBJECTIVE The authors sought to evaluate the roles of perioperative antibiotic prophylaxis in noninstrumented spine surgery (NISS), both in postoperative infections and the impact on the selection of resistant bacteria. To the authors’ knowledge, only one prospective study recommending preoperative intravenous (IV) antibiotics for prophylaxis has been published previously. METHODS Two successive prospective IV antibiotic prophylaxis protocols were used: from 2011 to 2013 (group A: no prophylactic antibiotic) and from 2014 to 2016 (group B: prophylactic cefazolin). Patient infection rates, infection risk factors, and bacteriological status were determined. RESULTS In total, 2250 patients (1031 in group A and 1219 in group B) were followed for at least 1 year. The authors identified 72 surgical site infections, 51 in group A (4.9%) and 21 in group B (1.7%) (p < 0.0001). A multiple logistic regression hazard model identified male sex (HR 2.028, 95% CI 1.173–3.509; p = 0.011), cervical laminectomy (HR 2.078, 95% CI 1.147–3.762; p = 0.016), and postoperative CSF leak (HR 43.782, 95% CI 10.9–189.9; p < 0.0001) as independent predictive risk factors of infection. In addition, preoperative antibiotic prophylaxis was the only independent favorable factor (HR 0.283, 95% CI 0.164–0.488; p < 0.0001) that significantly reduced infections for NISS. Of 97 bacterial infections, cefazolin-resistant bacteria were identified in 26 (26.8%), with significantly more in group B (40%) than in group A (20.9%) (p = 0.02). CONCLUSIONS A single dose of preoperative cefazolin is effective and mandatory in preventing surgical site infections in NISS. Single-dose antibiotic prophylaxis has an immediate impact on cutaneous flora by increasing cefazolin-resistant bacteria.

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