Implant survival after deep infection of an instrumented spinal fusion

Núñez-Pereira, Susana; Pellisé, Ferràn; Rodríguez-Pardo, Dolors; Pigrau, Carlos; Bagó, Joan; Villanueva, Càndid; Cáceres, Enric

doi:10.1302/0301-620x.95b8.30784

Cited by 38 publications

(41 citation statements)

References 26 publications

(34 reference statements)

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“…The pooled average re-operation rate for all identified spine surgery-related SSIs was calculated to be 67.1% (median, 100%; range, 33.5%–100%) among 1,704 procedures that developed SSIs. This rate is lower than that for instrumented spinal fusion, which was calculated to be 89.2% (median, 100%; range, 56.8%–100%) among 148 procedures that developed SSIs [37,39,48,78,97,112,121,132] and that for spinal fusion, which was calculated to be at 86.4% (median, 100%; range, 50%–100%) among 22 procedures that developed SSIs [58,72,76,111,142,173]. However, the smaller denominators should be considered when comparing the re-operation rates by type of surgery with the overall rate (i.e., 148 and 22 versus 1,704).…”

Section: Resultsmentioning

confidence: 99%

“…The pooled average SSI rate was calculated to be 1.6% (median, 2.8%; range, 0.2%–18.3%) based on 64 cohorts comprising a total of 212,639 patients. Patients who underwent instrumented spinal fusion procedures were evaluated for SSIs in 35 identified studies [6,12,25,28,35,37,39,48,50,61,67,74,77,78,84,85,90,93,97,98,101,112,121,122,126,127,132,134,135,137,148,154,156,160,174]. The pooled average SSI rate was calculated to be 3.8% (median, 4.2%; range, 0.4%–20%) based on 39 cohorts with a total of 28,628 patients.…”

Section: Resultsmentioning

confidence: 99%

“…In a large retrospective Japanese study of 7,178 patients who had spine surgery, the mortality rate was reported to be 2.2% among those who developed SSIs [13]. Similarly, a relatively smaller retrospective Spanish study of 481 patients who underwent posterior spinal fusion and instrumentation reported a mortality rate of 2.3% among patients who developed deep SSIs [97]. Last, a retrospective analysis of data from a Japanese nationwide administrative inpatient database reported that among 465 patients who underwent spinal fusion surgery for atlantoaxial subluxation and had rheumatoid arthritis, the in-hospital mortality rate was 6.7% among patients who developed SSIs [46].…”

Section: Resultsmentioning

confidence: 99%

“…Re-operation rates resulting from SSIs developing after select spine operations were reported by 26 studies (Fig. 4) [11,13,20,37–39,47,48,58,72,76,78,95,97,100,106,111,112,117,121,131,132,142,147,169,173]. The pooled average re-operation rate for all identified spine surgery-related SSIs was calculated to be 67.1% (median, 100%; range, 33.5%–100%) among 1,704 procedures that developed SSIs.…”

Section: Resultsmentioning

confidence: 99%

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

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

View full text Add to dashboard Cite

show abstract

“…Kowalski et al [15] reported that the presence of pre-existing malignancy or radiation therapy were significant risk factors for treatment failure [15] . Núñez-Pereira et al [8] reported that 8.9% of patients treated with posterior spinal fusion and instrumentation had a deep SSI; multivariate analysis revealed a significant risk of treatment failure in patients who developed sepsis or who had >3 fused segments [8] . In contrast, we found that a higher number of fused segments was not a risk factor for treatment failure, which was defined as implant removal after SSI.…”

Section: Discussionmentioning

confidence: 99%