Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization

Abstract

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality.The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study.Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI.Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

A cross-sectional study of surgical glove perforation during the posterior lumbar interbody spinal fusion surgery

“…[5,9] Orthopedic surgery, in particularly fracture, arthroplasty, and spinal fusion have a higher rate of perforation occurrence, possibly due to a greater likelihood of perforation from sharp bone fragment, the use of complex surgical instruments, and various bone structures. [5,6,10–14] Since the introduction of the PLIFs by Cloward in the 1950s, the advent of durable interbody fusion cages and bone grafting alternatives has lessened the morbidity of bone graft harvesting and disc space collapse and has provided improved stiffness and stability to the affected spinal motion segment. [15] Therefore, the procedure that is fine trimming of a local bone for use as interbody graft material is essential in the PLIFs.…”

Frequency of Undetected Glove Perforation and Associated Risk Factors in Equine Surgery

“…7,8 A large retrospective study of spinal surgeries in people found increased risk of SSI with glove perforations, even when perioperative antimicrobials were administered. 9 Two other studies in people have however, not found an association between SSI and glove perforations. 3,10 Prolonged surgery duration in people increases both the risk of glove perforation and the risk of bacterial contamination of the hand or glove, with recommendations that changing gloves frequently and potentially disinfecting the hands between glove changes would decrease the bacterial contamination and rate of perforations.…”

“…This is of interest since the justification of using antimicrobials in clean equine surgery is questioned . A large retrospective study of spinal surgeries in people found increased risk of SSI with glove perforations, even when perioperative antimicrobials were administered . Two other studies in people have however, not found an association between SSI and glove perforations …”

Is implant washing and wound irrigation with rifampicin effective for preventing surgical site infections in lumbar instrumentation?

“…Yaldiz et al retrospectively evaluated 540 cases undergoing posterior stabilization due to degenerated lumbar spine and reported 17 postoperative infection cases with different parameters (24). They concluded that the presence of systemic illness, unknown punctures in surgical gloves, and peroperative blood transfusion may increase the prevalence of post-operative infections.…”