Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.</jats:p></jats:sec>

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

“…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. Patients who underwent instrumented spinal fusion procedures were evaluated for SSIs in 35 identified studies [6,12,25,28,35,37,39,48,50,61,67,74,77,78,84,85,90,93,97,98,101,112,121,122,126,127,132,134,135,137,148,154,156,160,174]. The pooled average SSI rate was calculated to be 3.8% (median, 4.2%; range, 0.4%–20%) based on 39 cohorts with a total of 28,628 patients.…”

“…A total of 39 studies evaluating S. aureus SSI rates among patients who underwent spine operations of interest were included in this study (Table 1A) [6,7,10–15,32,37,45,47,48,52,53,62,77,84,90,91,101,103,111–113,117,122,126,129,132,137,138,140,146,155,160,164,167,173]. The pooled average S. aureus SSI rate was calculated to be 1% (median, 2%; range, 0.02%–10%) based on 42 cohorts evaluating a total of 112,135 patients.…”

“…On the basis of nine studies with nine cohorts consisting of a total of 9,604 patients who underwent spinal fusion, the calculated pooled average rate was 1.8% (median, 2.6%; range, 1.1%–8.3%) [14,15,52,62,103,113,146,164,173]. According to 13 studies consisting of 14 cohorts with a total of 14,835 patients who underwent instrumented spinal fusion, the calculated pooled average rate was 1.4% (median, 2%; range, 0.1%–10%) [6,37,48,77,84,90,101,112,122,126,132,137,160]. The pooled average contribution of S. aureus infections to spinal SSIs was calculated to be 49.3% (median, 50%; range, 16.7%–100%; 2,272 SSIs) [6,7,10–15,32,37,45,47,48,52,53,62,77,84,90,91,101,103,111–113,117,122,126,129,132,137,138,140,146,155,160,164,167,173].…”

Complications of surgical intervention in adult lumbar scoliosis

“…In the SRS database of more than 100,000 operations, higher infection rates were seen with use of implants (28 % greater, 2.3 vs 1.8 %), spinal fusion (33 % greater, 2.4 vs 1.8 %), and revision surgery (65 % greater, 3.3 vs 2.0 %) [20]. Surgical variables included inadequate antibiotic dosing, longer operative time/number of levels, pelvic fixation, and blood transfusions and have all been associated with surgical site infections [17,19,21,22]. Obesity, smoking, diabetes/serum glucose, and MRSA colonization are potentially modifiable risk factors associated with increased rates of surgical site infections [16].…”

Increased Operative Time for Benign Cranial Nerve Tumor Resection Correlates with Increased Morbidity Postoperatively

“…In other surgical specialties, operative time has been linked to increased rates of infection, length of stay, and morbidity. [2][3][4] Longer operative times in patients undergoing VS surgery have been associated with increased incidence of cerebrospinal fluid (CSF) leaks postoperatively. 10 We hypothesize that increased operative time may be associated with higher rates of other postoperative complications as well.…”