Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Surgical site infection (SSI) following spine surgery causes major morbidity and greatly impedes functional recovery. In the modern era of advanced operative techniques and improved perioperative care, SSI remains a problematic complication that may be reduced with institutional practices. The objectives of this study were to 1) characterize the SSI rate and microbial etiology following spine surgery for various thoracolumbar diseases, and 2) identify risk factors that were associated with SSI despite current perioperative management.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>All patients treated with thoracic or lumbar spine operations on the neurosurgery service at the University of California, San Francisco from April 2012 to April 2016 were formally reviewed for SSI using the National Healthcare Safety Network (NHSN) guidelines. Preoperative risk variables included age, sex, BMI, smoking, diabetes mellitus (DM), coronary artery disease (CAD), ambulatory status, history of malignancy, use of preoperative chlorhexidine gluconate (CHG) showers, and the American Society of Anesthesiologists (ASA) classification. Operative variables included surgical pathology, resident involvement, spine level and surgical technique, instrumentation, antibiotic and steroid use, estimated blood loss (EBL), and operative time. Multivariable logistic regression was used to evaluate predictors for SSI. Odds ratios and 95% confidence intervals were reported.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>In total, 2252 consecutive patients underwent thoracolumbar spine surgery. The mean patient age was 58.6 ± 13.8 years and 49.6% were male. The mean hospital length of stay was 6.6 ± 7.4 days. Sixty percent of patients had degenerative conditions, and 51.9% underwent fusions. Sixty percent of patients utilized presurgery CHG showers. The mean operative duration was 3.7 ± 2 hours, and the mean EBL was 467 ± 829 ml. Compared to nonfusion patients, fusion patients were older (mean 60.1 ± 12.7 vs 57.1 ± 14.7 years, p &lt; 0.001), were more likely to have an ASA classification &gt; II (48.0% vs 36.0%, p &lt; 0.001), and experienced longer operative times (252.3 ± 120.9 minutes vs 191.1 ± 110.2 minutes, p &lt; 0.001). Eleven patients had deep SSI (0.49%), and the most common causative organisms were methicillin-sensitive <jats:italic>Staphylococcus aureus</jats:italic> and methicillin-resistant <jats:italic>S. aureus</jats:italic>. Patients with CAD (p = 0.003) or DM (p = 0.050), and those who were male (p = 0.006), were predictors of increased odds of SSI, and presurgery CHG showers (p = 0.001) were associated with decreased odds of SSI.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This institutional experience over a 4-year period revealed that the overall rate of SSI by the NHSN criteria was low at 0.49% following thoracolumbar surgery. This was attributable to the implementation of presurgery optimization, and intraoperative and postoperative measures to prevent SSI across the authors’ institution. Despite prevention measures, having a history of CAD or DM, and being male, were risk factors associated with increased SSI, and presurgery CHG shower utilization decreased SSI risk in patients.</jats:p></jats:sec>

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

“…In our cohort of patients, we found out that obesity (abnormal level of BMI above 30 kg/m 2 ) is a signifi cant risk factor for the incidence of postoperative symptomatic SEDH. Our fi ndings confi rm previous studies -the incidence of symptomatic SEDH requiring evacuation ranges from 0.1 % to 3.7 % (3,(9)(10)(11).…”

Average Lumbar Hounsfield Units Predicts Osteoporosis-Related Complications Following Lumbar Spine Fusion

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10-kHz Spinal Cord Stimulation Treatment for Painful Diabetic Neuropathy: Results from Post-Hoc Analysis of the SENZA-PPN Study

“…Anatomic placement of 10 kHz SCS leads do not require paresthesia mapping allowing for procedural efficiency leading to patient safety and comfort [31]. Moreover, a predictable and shorter procedure time could potentially reduce the risk of infection at the surgical site, which poses an increased risk in patients with diabetes who undergo thoracolumbar surgery [32]. The paresthesia-free nature of 10 kHz SCS also avoids the potential for painful or uncomfortable paresthesia that some subjects experience with LF-SCS [18].…”