Operative Duration as an Independent Risk Factor for Postoperative Complications in Single-Level Lumbar Fusion

Kim, Bobby D.; Hsu, Wellington K.; Oliveira, Gildàsio S. De; Saha, Sujata; Kim, John Y.S.

doi:10.1097/brs.0000000000000163

Cited by 177 publications

(122 citation statements)

References 46 publications

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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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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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“…The multifaceted nature of this changed and enhanced protocol hinders our ability to derive which component contributed most substantially to the reduced infection rate. Evidence suggests that multiple of the enhancements may affect the prevention of SSI, from preoperative skin preparation protocol to irrigation to antibiotic usage [14, 15, 21, 22, 26-28]. Future studies should include analysis by type of surgery and indication for surgery.…”

Section: Discussionmentioning

confidence: 99%

Reduced Surgical Site Infection Rates Following Spine Surgery Using an Enhanced Prophylaxis Protocol

Dessy

Yuk

Maniya

et al. 2017

Cureus

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BackgroundPostoperative surgical site infection (SSI) is a common complication after spine surgery. Reduction of SSI has many benefits including, but not limited to, the reduced length of stay, readmission rates, and morbidity and mortality.ObjectiveTo determine whether an enhanced antibiotic prophylaxis reduced the rate of surgical site infections in spine surgery.MethodsThis is a retrospective observation study which analyzed the incidence of postoperative SSI following a consecutive series of 1,486 cervical, thoracic and lumbar spine operations performed at a single institution by the senior author between the dates of October 2001 to March 2014. Patients with surgeries between October 2001 and November 2005 received a standard institutional antibiotic prophylaxis. Patients between December 2005 and March 2014 underwent an enhanced antibiotic protocol.ResultsA total of nine cases met the criteria for SSI. All nine cases were recorded during the initial time period when the standard institutional prophylaxis was used. Further, these cases were only observed under posterior operative approaches. No further cases of SSI were observed after the institution of the enhanced antibiotic prophylaxis (p < 0.0001). This was statistically significant in the cervical and lumbar regions (p < 0.0042 and p < 0.0119, respectively).ConclusionsAlthough difficult to predict the incidence of SSI, this study found that the use of an enhanced antibiotic prophylaxis protocol significantly reduced one surgeon’s overall rates of surgical site infections after spine surgery.

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“…Others looked into treatments specific to surgical procedures and the levels of pain to be expected after these procedures . Others analyzed the influence of duration of surgery on pain . Further topics included the challenges of pain assessment, particularly in understaffed wards, insecure employees with floods of information, and ongoing discourses on valid gold standards in treatment .…”

Section: Discussionmentioning

confidence: 99%

Pain Assessment Discrepancies: A Cross‐Sectional Study Highlights the Amount of Underrated Pain

Ransbeeck

Budilivski²,

Spahn

et al. 2017

Pain Practice

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Operative Duration as an Independent Risk Factor for Postoperative Complications in Single-Level Lumbar Fusion

Abstract: 3.

Cited by 177 publications

References 46 publications

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

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

Reduced Surgical Site Infection Rates Following Spine Surgery Using an Enhanced Prophylaxis Protocol

Pain Assessment Discrepancies: A Cross‐Sectional Study Highlights the Amount of Underrated Pain

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