Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience

Adogwa, Owoicho; Fatemi, Parastou; Peréz, Edgar; Moreno, Jessica; Chagoya, Gustavo; Gokaslan, Ziya L.; Cheng, Joseph; Gottfried, Oren N.; Bagley, Carlos A.

doi:10.1016/j.spinee.2014.04.011

Cited by 82 publications

(80 citation statements)

References 22 publications

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“…Typical postoperative interventions such as meticulous wound care by trained nursing staff, timely administration of antibiotics, routine skin assessment or monitoring devices for pressure sores, and negative pressure wound therapy can all be implemented to reduce the risk of dehiscence in patients undergoing spinal surgery. 22 Even marginal decreases in local wound complications could have a major impact on the 12-day increase in LOS that our data demonstrate. Although the nonnormality of the data prohibited similar estimations of LOS increase for other specific complications, these data strongly encourage the participation of plastic surgeons early on in the care of these patients.…”

Section: Discussionmentioning

confidence: 58%

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Carl

Coon

Calotta

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Posterior trunk reconstruction is increasingly possible as a result of advances in spinal instrumentation, reconstructive approaches, and perioperative critical care. Extensive cases often require a muscle flap or complex closure to obliterate dead space. Postsurgical wound complications and subsequent reoperations can lead to neural injury, higher hospital costs, and longer hospitalizations. We aim to identify risk factors that are associated with increased length of stay (LOS) for patients receiving flaps to close a spinal defect.Methods:A single institution, retrospective cohort study was performed on all patients from 2002 to 2014 who received a muscle flap to close a spine defect. Medical and perioperative variables that were significantly associated with LOS (P < 0.05) in univariate analysis were included in a stepwise regression model.Results:A total of 288 cases were identified. Presence of instrumentation, preoperative chemotherapy, wound dehiscence, cerebrospinal fluid leak, partial/total flap loss, and medical morbidity occurrence were all independently associated with increased LOS in a combined multivariate model (P < 0.02 for each of the 6 variables). Importantly, Kaplan–Meier analysis demonstrated that postoperative wound dehiscence increased LOS by 12 days.Conclusions:Spinal tumor resections often create large cavitary defects that necessitate the use of muscle flaps for closure. Patients who have received adjuvant chemotherapy require instrumentation, or those who develop specific wound-related or medical complications are at increased risk for prolonged hospitalization after spinal reconstruction. Thus, implementing measures to mitigate the occurrence of these adverse events will reduce costs and decrease the length of hospitalization.

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Section: Discussionmentioning

confidence: 58%

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Carl

Coon

Calotta

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…Evidence suggests that the SSI rate after spine surgery could be reduced by around 30% if this technique were implemented routinely, 26 meaning that five fewer patients may have suffered SSI over the four year study period presented in our current study. This would translate into a saving of approximately £38,000 in costs associated with in-patient stay alone.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 72%

“…That being said, given the urgent nature of some types of surgical cases and the potential for catastrophic outcomes were SSI to occur, it could be argued that interventions which may have the potential to reduce the infection rate by any substantial degree -despite them being more costly from the outset -may be warranted. A full economic analysis in future studies of such interventions would help to determine whether the initial outlay on systems such as NPWT -which have shown promise in stimulating wound healing and preventing SSI in some scenarios 14,26,27 is cost-effective in the longer term, if used in patients at high risk of wound complications. Indeed, any prospective full economic study should assess costs relating to all aspects of care including out-patient and community services (something which was beyond the scope of the current investigation) in order to count the full financial cost of SSI.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis

Atkinson

Jones

Ousey

et al. 2017

Journal of Hospital Infection

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The pooled average early SSI rate among 14,517 patients was 2.1% (median, 2.6%; range, 0.5%–16.7%) [11,13,20,22,25,32,78,82–84,86,142,147,156,164,167,170,171] compared with 0.8% (median, 0.9%; range, 0.1%–4.7%) for pooled average late SSI rate among 12,238 patients [11,13,54,83,167,171]. In terms of specific types of spine operations, 52 studies evaluated SSI rates among patients who underwent spinal fusion [9,10,14,15,21,24,27,30,33,42,43,46,52,56,58,62,63,68–70,72,75,76,92,103,105,107–109,111,113–115,119,120,123,125,128,133,139,141–144,146,150,151,157,161,162,164,173]. 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.…”

Section: Resultsmentioning

confidence: 99%

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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Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience

Cited by 82 publications

References 22 publications

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis

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

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