Early surgical site infections in adult spinal trauma: A prospective, multicentre study of infection rates and risk factors

Lonjon, Guillaume; Dauzac, C.; Fourniols, E.; Guigui, P.; Bonnomet, F.; Bonnevialle, P.

doi:10.1016/j.otsr.2012.07.006

Cited by 60 publications

(51 citation statements)

References 30 publications

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“…Previous studies have suggested that surgery performed at more than three vertebral levels is associated with greater infection risk [6,15], though these analyses were not confined only to patients undergoing tumour and surgery. Although primary spinal region (thoracic or non-thoracic) was not found to be significantly associated with SSI, when controlling for number of spinal levels involved in the surgical procedure, the odds of an SSI increase by a factor of approximately 5.6 (at best estimate) when the primary surgical region is the thoracic, as opposed to the cervical or lumbar regions.…”

Section: Discussionmentioning

confidence: 99%

An assessment of key risk factors for surgical site infection in patients undergoing surgery for spinal metastases

et al. 2016

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1 Objectives 2This study aimed to determine the rate of surgical site infection (SSI) in patients undergoing surgery 3 for spinal metastases, and identify key risk factors for SSI among this patient group. 4 Methods 5A retrospective case note review was undertaken in 152 adult patients being treated at a single 6 specialist centre for spinal surgery. 7 Results 8Overall SSI rate was 11.2% per patients (9.7% per procedure). An increase in the risk of SSI was 9 observed when surgery involved a greater number of vertebral levels (odds ratio 1.26, P=0.019) 10 when controlling for primary spinal region. Controlling for the number of spinal levels, the odds of 11 SSI increased by a factor of 5.6 (P=0.103) when the primary surgical region was thoracic, as opposed 12 to cervical or lumbar. 13 Conclusions 14In conclusion, surgery associated with multiple vertebral levels for treatment of spinal metastases, 15particularly of the thoracic spine, is associated with increased risk of SSI. 17

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Section: Discussionmentioning

confidence: 99%

An assessment of key risk factors for surgical site infection in patients undergoing surgery for spinal metastases

et al. 2016

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“…Previous publications reported that operations of the lumbar and sacral spine were risk factors for SSI; however we could not achieve statistical significance for these attributes. 4, 21-23 An increase in the number of spinal levels involved in a procedure can be linked to a longer operative time, however only the latter was found to be a significant risk factor. Despite a lack of statistical significance, SSI cases were found to have a mean estimated blood loss (EBL) of 400 cc more than non-SSI cases.…”

Section: Discussionmentioning

confidence: 99%

Reducing Surgical Site Infection in Spinal Surgery With Betadine Irrigation and Intrawound Vancomycin Powder

Tomov

Mitsunaga

Durbin‐Johnson

et al. 2015

Spine

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Study Design Retrospective analysis. Objective The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. Summary of Background Data SSI is an undesired complication of orthopaedic spine surgeries. It poses a significant risk to the patient, as well as a financial toll on the healthcare system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. Methods A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 gram of intra-wound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed effects logistic regression in a univariate fashion. Risk factors with p-values of ≤ 0.05 in univariate analysis were included together in a multivariate mixed effects logistic regression model. Results SSI rates were reduced by 50% following the intervention; Chi square analysis comparing the SSI rates between the pre- and post-intervention periods yielded a p-value of 0.042. Rates of methicillin resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multi-bacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (OR 0.93), anemia (OR 30.73), prior operation (OR 27.45), and vertebral fracture (OR 22.22). Conclusion The combination of Betadine wound irrigation and intra-wound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols.

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“…3,19-22 Other authors demonstrated increased infection rate in patients with diabetes, alcohol abuse, nicotine abuse, obesity, and previous surgeries. 4,23-25 Olsen et al . 26 showed that diabetes and elevated level of glucose preoperatively was associated independently with increased risk of infected wound.…”

Section: Discussionmentioning

confidence: 99%

Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients

et al. 2013

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We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.

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Early surgical site infections in adult spinal trauma: A prospective, multicentre study of infection rates and risk factors

Abstract: Level IV, prospective cohort study.

Cited by 60 publications

References 30 publications

An assessment of key risk factors for surgical site infection in patients undergoing surgery for spinal metastases

An assessment of key risk factors for surgical site infection in patients undergoing surgery for spinal metastases

Reducing Surgical Site Infection in Spinal Surgery With Betadine Irrigation and Intrawound Vancomycin Powder

Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients

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