Postoperative Infection Treatment Score for the Spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection

DiPaola, Christian P.; Saravanja, Davor; Boriani, Luca; Zhang, Hongbin; Boyd, Michael; Kwon, Brian K.; Paquette, Scott; Dvorak, Marcel F.; Fisher, Charles G.; Street, John

doi:10.1016/j.spinee.2012.02.004

Cited by 61 publications

(50 citation statements)

References 44 publications

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“…Although the infection rate for the midline patients may appear high, it is consistent with the previously published infection rate at our center and other recent publications that evaluated degenerative lumbar spondylolisthesis. 5,21 Many potential barriers exist in the adoption of this surgical approach. Often, surgeons who are trained using a midline approach assume that decompression of central stenosis cannot be as adequately or safely performed from lateral to medial.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Street

Glennie

Dea

et al. 2016

SPI

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OBJECTIVE The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. METHODS A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher's exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. RESULTS All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23–0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. CONCLUSIONS The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and infection, less blood loss, and fewer reoperations than the midline patients. The risk of adjacent segment failure in short posterior constructs is lower with a Wiltse approach.

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Section: Discussionmentioning

confidence: 99%

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Street

Glennie

Dea

et al. 2016

SPI

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“…Except for the thoracolumbar area in the patient with MMC, the monofilament test showed a threshold of 3.61 in all reconstructed areas, indicating that protective sensibility was obtained in these areas. The average hospital stay after wound closure was 10 days (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. During the follow-up period (mean 65 mo, range 7-106) 1 patient developed an infection in the operated area 81 months postoperatively.…”

Section: Resultsmentioning

confidence: 99%

“…1-3 Debridement and irrigation combined with culture-specific antibiotic administration is the mainstay treatment of these complications. 4 For a successful outcome it is essential to provide stable soft tissue coverage of the defect after infection control has been obtained. Coverage may be obtained with wide skin undermining and advancement.…”

Section: Study Design Prospective Studymentioning

confidence: 99%

Closure of Complex Posterior Midline Defects After Spinal Surgery With Sensate Midline-based Perforator Flaps and the Long-term Results

Weerd

Weum

2015

SPINE

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“…To the best of our knowledge, there is no randomized prospective trial targeting the number of debridement for outcome remission. There is very little evidence to guide surgical treatment of patients who require a single versus multiple debridement (28) bone grafts (28). Due to the small sample size for each of these particular variables, we could not confirm or reject their model.…”

Section: Discussionmentioning

confidence: 95%

Variables associated with remission in spinal surgical site infections

Billières¹,

Uçkay²,

Faúndez³

et al. 2016

J. Spine Surg.

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Background: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.Methods: Single-centre case-control study [2007][2008][2009][2010][2011][2012][2013][2014]. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.Results: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements.The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Conclusions:In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

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Postoperative Infection Treatment Score for the Spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection

Cited by 61 publications

References 44 publications

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Closure of Complex Posterior Midline Defects After Spinal Surgery With Sensate Midline-based Perforator Flaps and the Long-term Results

Variables associated with remission in spinal surgical site infections

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