Risk factors for surgical site infection after instrumented fixation in spine trauma

Abstract

Surgical site infection (SSI) represents a significant complication after instrumented fixation in spine changes have emphasized early fracture correction, shortened intraoperative times, early ambulation, and prompt nutritional supplementation. This retrospective study evaluates the senior author’s experience of instrumented spinal trauma SSI occurring at a single Level I trauma center over two equal and contiguous time periods, 2005–2007 (before nutritional supplementation was added to the institutional protocol) and 2008–2010 (after nutritional supplementation was added). This study assessed whether SSI varied depending on the primary surgical site and/or by the chosen approach. Lastly, the incidence of SSI among demographic and other clinical variables was evaluated. In total, 358 patients underwent an index procedure for spinal trauma correction. Fourteen patients developed a SSI requiring reoperation for an incidence of 4.0%. In assessing nutritional supplementation, the probability of infection tended to be lower in the supplemented group (3.7%) than the pre-supplement group (4.3%), but this did not reach significance. The difference in approach for the cervical spine was statistically significant (p = 0.045) with rates of infection via posterior approach at 8.1% and no infections via anterior approach. Presence of comorbidities (p = 0.03) and time to surgery >3 days (p = 0.006) were predictors of developing SSI. Benefit is shown from early surgical correction of spinal trauma patients in the reduction of postoperative SSI. Nutritional supplementation may provide a small reduction in infections in the spine trauma population.

Surgical Site Infection Following Open Posterior Spine Surgery: Which is the Most Affected?

“…Our result revealed that age 41-66 years was the commonest group with spinal disorders ( Table 1). Previous studies found that the mean age for spinal disorder ranges from 44.2±16.0 to 63±14 years (5)(6)(7)(8)10,12,14,16,18,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). This indicates that our result was consistent with previous findings.…”

“…Moreover, twenty studies reported were identified from PubMed and EMBASE regarding the incidence of SSI following spine surgery. They reported the incidence vary, ranging from 0.2% to 16.1% (5)(6)(7)(8)10,12,14,16,18,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Our result showed that the incidence of SSI following spine surgery was 2.4%.…”

“…Our result was different with several studies. Studies found that trauma and or degenerative in cervical (8,18,27,28,32), thoracic (12), and lumbar spine (6,7,10) were the commonest cases associated with SSI. This difference could not be clearly explained.…”

“…Although its incidence in spinal surgery is relatively infrequent event, SSIs are proven to be correlated with a high morbidity, mortality, increased additional cost and resource utilization (1). In addition, studies revealed that SSIs are also correlated with a long duration of surgery usually longer than three hours (17,18). Given the fact that the mean surgical time for spinal disorder is about four hours (19), therefore SSIs are potentially acquired among spinal disorder surgical procedures.…”

Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A propensity score-matched analysis

“…Surgical site infections are associated with high morbidity, mortality, and health-care costs [1,2]. Despite the ubiquity of prophylactic antibiotics and aseptic techniques, SSIs occur at a rate of 0.6%-12% in patients undergoing instrumented spinal surgery [3][4][5][6][7][8].…”