Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005–2012

Sebastian, Arjun S.; Huddleston, P.M.; Kakar, Sanjeev; Habermann, Elizabeth B.; Wagie, Amy E.; Nassr, Ahmad

doi:10.1016/j.spinee.2015.12.009

Cited by 142 publications

(97 citation statements)

References 35 publications

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“…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.…”

Section: Discussionsupporting

confidence: 93%

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

Azharuddin¹,

Harapan²,

Fajar³

2018

BTDMJB

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Amaç: Cerrahi alan enfeksiyonu (CAE), cerrahi yara iyileşme bozukluklarının önemli bir nedenidir. CAE, açık posterior omurga cerrahisinde nadir olmakla birlikte; ciddi morbidite, artan kaynak kullanımı ve mortalite ile potansiyel olarak ilişkilidir. Açık posterior omurga cerrahisi ile tedavi edilen çeşitli omurga bozuklukları ve CAE riski arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Ocak 2012-Aralık 2015 tarihleri arasında, Dr. Zainoel Abidin Kamu Hastanesi'nde elde edilen veriler ile retrospektif bir çalışma yürütüldü. Açık posterior omurga cerrahisi ile tedavi edilen omurga bozuklukları ve CAE riski verileri tıbbi kayıtlardan toplandı; tedavi edilen omurga bozuklukları ve CAE insidansı arasındaki ilişki ki-kare testi ile değerlendirildi. Bulgular: Açık posterior omurga cerrahisi ile tedavi edilen toplam 289 hastadan 7 (%2,4) CAE'li hasta incelendi. Spinal tüberküloz, CAE riskinin 5,9 kat artmasıyla ilişkiliydi [odds oranı %95, güven aralığı= 5,99 (1,14-31,51), p=0,034]. Spinal stenoz (p=0,311), omurga kırığı (p=0,759), fıtıklaşmış nukleus pulposus (p=0,484), omurga çıkıkları (p=0,806), spondilolistezis (p=0,925), omurga tümörü (p=0,491) ve skolyoz (p=0,707) gibi diğer omurga hastalıkları CAE riski ile anlamlı ilişki göstermemiştir. Sonuç: Popülasyonumuzda spinal tüberkülozun CAE riski ile ilişkili olduğu gösterilmiştir. Anahtar kelimeler: Cerrahi alan enfeksiyonu, açık posterior omurga cerrahisi, omurga bozuklukları, spinal tüberküloz, risk faktörü Objective: Surgical site infection (SSI) is an important cause of surgical wound healing disorders. Although SSI is uncommon in open posterior spine surgery, it is potentially correlated with serious morbidity, increased resource utilization and mortality. To evaluate the association between several spinal disorders treated with open posterior spine surgery and the risk of SSI. Materials and Methods: A retrospective study was conducted in Dr. Zainoel Abidin General Hospital included data during January 2012 to December 2015. The data of the spinal disorders treated with open posterior spine surgery and the risk of SSI were extracted from medical record. A chi-square was employed to assess the association between spinal disorders treated with open posterior spine surgery and the incidence of SSI. Results: A total of seven (2.4%) SSIs of 289 patients treated with open posterior spine surgery were analyzed. Spinal tuberculosis was associated with 5.9 fold increased the risk of SSI [odds ratio 95% confidence interval= 5.99 (1.14-31.51), p=0.034]. While, other spinal disorders including spinal stenosis (p=0.311), spine fracture (p=0.759), herniated nucleus pulposus (p=0.484), spinal dislocations (p=0.806), spondylolisthesis (p=0.925), spinal tumor (p=0.491), and scoliosis (p=0.707) had no significant association with the risk of SSI. Conclusion: In our population, spinal tuberculosis is indicated to be correlated with the risk of SSI.

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Section: Discussionsupporting

confidence: 93%

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

Azharuddin¹,

Harapan²,

Fajar³

2018

BTDMJB

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“…Numerous studies have described a strong association between BMI and SSI. 1,13,20,27 Interestingly, a handful of others have equally disagreed with this association. 15,22,30,32 Buerba et al 3 suggested that a BMI threshold ≥ 40 kg/m 2 may be more of a risk factor for SSI than all BMIs > 30 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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“…The accuracy of data collection by the NSQIP (including cumulative incidence and reasons for readmission) has been externally validated, 84 and this data source has been previously used to evaluate patients undergoing neurosurgical intervention, 4,8,12,14,15,28,29,45,54,83 including spine surgery. 2,6,9,10,25,40,53,59,61,82,91 Our institutional review board has exempted the de-identified NSQIP data set from individual review.…”

Section: Data Sourcementioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005–2012

Cited by 142 publications

References 35 publications

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

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

Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

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