Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Abstract

Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

Does the Application of Topical Intrawound Vancomycin Powder Affect Deep Surgical Site Infection and the Responsible Organisms after Spinal Surgery?: A Retrospective Case Series with a Historical Control Group

“…The leading cause of SSIs in spinal surgery is the presence of gram-positive bacteria, especially Staphylococcus aureus [2]. However, we found that gram-negative bacteria were the cause of SSI in our treatment group.…”

“…The type of the surgery influences the prevalence of spinal surgical site infections (SSIs). Instrumentation and fusion procedures have higher rates of infection than procedures without fusion [2]. In order to achieve high intrawound drug concentrations, local antibiotic administration has been utilized in addition to systemic antibiotic prophylaxis.…”

Spinal Cord Stimulation Infection Rate and Incremental Annual Expenditures: Results From a United States Payer Database

“…In this previous study, the physician authors recommend closely examining the patients with risk factors that were individually significant such as smoking, cardiac dysrhythmias, or sleep apnea, or factors that were near significance and assess them in the context with overall comorbidities and other patient characteristics to determine if additional infection prevention may be appropriate for that patient. Previous literature has identified diabetes, obstructive sleep apnea, and a history of chronic obstructive pulmonary disease as risk factors for surgical site infections . Although not reaching statistical significance, both the prevalence of diabetes mellitus and peripheral vascular disease were higher in the individuals that had an infection in the reimplantation group.…”

“…Even for patients whose devices are replaced, there could be significant negative impact on patient quality of life due to the infection and related treatment. Studies in other conditions have identified a significant impact of surgical site infection on patient quality of life . Further research is needed to understand the specific quality‐of‐life impact of SCS device‐related infections.…”

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

“…28 The most common organism causing infection after lumbar laminectomy with fusion is S aureus, estimated to account for up to 90% of all infection following these operations. 28 The incidence of MRSA in spinal surgery has been found to account for an estimated 25% to 52% of all S aureus isolates from infected spine procedures. 28 Infection with this microorganism is particularly worrisome, as prior studies have shown that treatment outcomes are less successful and more costly for patients.…”