Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Deep wound infections are one of the most common and serious complications of spinal surgery. The impact of such infections on long-term outcomes is not well understood. The purpose of this study was to evaluate the functional status and satisfaction in patients who suffered a deep wound infection after undergoing lumbar arthrodesis for symptomatic degenerative disc disease.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors conducted a prospective study in 13 patients with a clinical and radiological diagnosis of symptomatic degenerative lumbar stenosis and instability; after undergoing decompression and instrumentation-augmented arthrodesis, the patients suffered a deep wound infection (infection group). A 3:1 (39-patient) matched cohort was selected for comparison (control group). All surgeries were performed during the same period and by a single surgeon. The postoperative infections were all treated in a similar manner and the instrumentation was not removed. Both groups were followed up and assessed with validated outcome instruments: Numerical Rating Scale of pain, Oswestry Disability Index, 36-Item Short Form Health Survey, Beck Depression Inventory, and Hospital Anxiety and Depression Scale. Patient satisfaction was also determined.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The median follow-up duration was 22 months (range 6–108 months). The mean patient age was 62 ± 10 years, and 59.6% of the patients were female. There was no significant difference between the groups in pain, functional disability, quality of life, or depression and anxiety. However, 53.8% of the patients with infection were not satisfied with the procedure at the final evaluation, compared with 15.4% of the patients without a deep wound infection (p = 0.003).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Patients with successfully treated postoperative deep wound infections do not have a difference in functional outcome compared with patients who underwent an identical operation but did not suffer a complicating infection. Patients who suffered an infection were more likely to be unsatisfied with the procedure than patients who did not.</jats:p></jats:sec>

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

“…They did not, however, identify significant differences for overall QOL as measured by the 36-Item Short Form Health Survey (SF-36). In a prospective study evaluating infections following lumbar arthrodesis, Falavigna et al 11 found no difference in Oswestry Disability Index, SF-36, numerical rating scale, or Beck Depression Inventory values at the 2-year time point between patients with infections compared to those without. In the present study, we found that at 6 months postoperatively, the noninfection cohort had a statistically significantly improved QOL compared with the infection cohort.…”

“…These findings are similar to those of previous lumbar fusion studies. 11,23 Although the long-term impact of postoperative dorsal cervical infection on QOL is minimal, these complications substantially increase the financial burden to the patient and the health care system. In a time of increased fiscal consciousness, federal departments and hospitals are attempting to minimize recovery costs and preventable complications.…”

Health Utility Values Associated with Surgical Site Infection: A Systematic Review

“…Of the nine patient-level studies (Table 2), three referred to spinal surgery [57][58][59], one each referred to hip [60], cardiac [61], and orthopedic surgery [56], and three studies included patients undergoing various interventions [11,36,62]. Seven studies [11,36,57,[59][60][61][62] predominantly enrolled patients older than 50 years.…”

“…Seven studies [11,36,57,[59][60][61][62] predominantly enrolled patients older than 50 years. The sample sizes ranged from 32 [59] to 1301 [62], with five studies [56][57][58][59][60] smaller than 100 patients.…”

Prevention of Surgical Site Infection in Spine Surgery

“…Kuhns et al 5 reported that 1-year pain and functional outcomes were not adversely affected by SSI after posterior cervical fusion. In another retrospective cohort study after lumbar fusion, Falavigna et al 6 found that pain and function outcome was unaffected by SSI but satisfaction was significantly poorer.…”