Risk factors for surgical site infection in elective routine degenerative lumbar surgeries

Klemencsics, Istvan; Lazáry, Áron; Szövérfi, Zsolt; Bozsodi, Arpad; Éltes, Péter Endre; Varga, Péter Pál

doi:10.1016/j.spinee.2016.08.018

Cited by 72 publications

(47 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ishii et al performed a retrospective multicentre study of 3462 instrumented lumbar surgeries and found a 1.1% occurrence of deep wound infection. Klemencsics et al found a 3.6% prevalence of SSIs in a prospective study of 1030 elective degenerative lumbar surgeries. In another prospective study, Lee et al reported that the prevalence of SSI was 4.3% within 2 years following the spinal surgeries in a cohort of 1532 patients.…”

Section: Discussionmentioning

confidence: 99%

Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors

Liang

Rong

et al. 2019

International Wound Journal

View full text Add to dashboard Cite

The purposes of this study were to investigate the incidence of surgical site infection (SSI) following geriatric elective orthopaedic surgeries and identify the associated risk factors This was a retrospective two‐institution study. Between January 2014 and September 2017, patients aged 60 years or older undergoing elective orthopaedic surgeries were included for data collection and analysis. SSI was identified through the review of patients' medical records for the index surgery and through the readmission diagnosis of SSI. Patients' demographics, characteristics of disease, surgery‐related variables, and laboratory examination indexes were inquired and documented. Univariate and multivariate logistic analyses were performed to determine independent risk factors for SSI. There were 4818 patients undergoing elective orthopaedic surgeries, and within postoperative 1 year, 74 patients were identified to develop SSIs; therefore, the overall incidence of SSI was 3.64%, with 0.4% for deep and 1.1% for superficial infection. Staphylococcus aureus (25/47, 53.2%) and coagulase‐negative staphylococci (11/47, 23.4%) were the most common causative pathogens; half of S. aureus SSIs were caused by Methicillin‐resistant Staphylococcus aureus (MRSA) (12/25, 48.0%). Five risk factors were identified to be independently associated with SSI, including diabetes mellitus (odds ratio [OR], 3.7; 95% confidence interval [95% CI], 1.7‐5.6), morbid obesity (OR, 2.6; 95% CI, 1.3‐3.9), tobacco smoking (OR, 4.2; 95% CI, 2.1‐6.4), surgical duration>75th percentile (OR, 1.9; 95% CI, 1.0‐2.9), and ALB < 35.0 g/L (OR, 2.3; 95% CI, 1.3‐3.4). We recommend the optimisation of modifiable risk factors such as morbid obesity, tobacco smoking, and lower serum albumin level prior to surgeries to reduce the risk of SSI.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors

Liang

Rong

et al. 2019

International Wound Journal

View full text Add to dashboard Cite

show abstract

“…Patient characteristics such as smoking status, age, BMI, and the presence of multiple comorbidities have been identified as risk factors for SSI. [16][17][18] However, operative and environmental variables, such as the OR itself, have become areas of major interest. The impact of unidirectional laminar airflow, the number of individuals participating in the procedure, and the climate maintained in the OR have become important considerations to reduce airborne organisms and infection risk.…”

Section: Discussionmentioning

confidence: 99%

“…These results correlate with the existing literature. [16][17][18][24][25][26] Perioperatively, the use of vancomycin powder, presence of consistent unidirectional laminar airflow, and room temperature monitoring are important considerations, as they have been shown to influence infection rate in previous studies. 19,27 Temperature monitoring was not recorded in the present study, and laminar airflow was not found to significantly affect infection rates on bivariate analysis (P ¼ .528).…”

Section: Discussionmentioning

confidence: 99%

Effects of Operating Room Size on Surgical Site Infection Following Lumbar Fusion Surgery

et al. 2019

View full text Add to dashboard Cite

Background: Surgical site infections (SSIs) represent a devastating complication after spine surgery. Many factors have been identified, but the influence of operating room (OR) size on infection rate has not been assessed. Methods: Two thousand five hundred and twenty-three patients who underwent open lumbar spine fusion at a single institution between 2010 and 2016 were included. Patients were dichotomized into large versus small groups based on OR volume. Bivariate logistic regression and a final multivariate model following a multicollinearity check were used to calculate odds of infection for all variables. Results: A total of 63 patients (2.5%) developed SSIs with 46 (73%) in the larger OR group and 17 (27%) in the smaller OR group. The rate of SSIs in larger ORs was 3.02% compared with 1.81% in smaller ORs. Significant parameters impacting SSI in bivariate analysis included an earlier year of surgery, BMI. 30, more comorbidities, more levels decompressed and fused, smoking, and larger OR volumes. Multivariate analysis identified BMI. 30, Elixhauser scores, smoking, and increasing levels decompressed as significant predictors. Topical vancomycin was found to significantly decrease rate of infection in both analyses. Conclusions: OR size (large versus small) was ultimately not a significant predictor of infection related to rates of SSIs, although it did show a clinical trend toward significance, suggesting association. Future prospective analysis is warranted.

show abstract

“…Although older age has not been shown to be an independent risk factor for SSIs, 15 studies indicate that the mean age of patients who develop SSIs after spine surgery tends to be higher, 16,17 and patients older than the mid-50s can have a significantly higher risk for developing SSI. 18,19 Similarly, gender has not been shown to be one of the predictors of SSIs in various studies 15,17 ; however, there is sporadic evidence that female sex is an independent risk factor. 20 Obesity with body mass index (BMI) above 30 kg/m 2 and diabetes mellitus (DM) are among the important patient-related factors that have been shown to be associated with an increased risk of SSIs.…”

Section: Demographic Variables Patient Selection and Comorbidity Asmentioning

confidence: 99%

Current Strategies in Prevention of Postoperative Infections in Spine Surgery

Ateşok

Papavassiliou

Heffernan

et al. 2019

Global Spine Journal

View full text Add to dashboard Cite

Study Design: Narrative review. Objectives: Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden. Hence, preventive strategies to reduce the rate of SSIs after spine surgery have become vitally important. The purpose of this article was to summarize and critically analyze the available evidence related to current strategies in the prevention of SSIs after spine surgery. Methods: A literature search utilizing Medline database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease the risk of SSIs have been provided based on the results from studies with the highest level of evidence. Results: SSI prevention occurs at each phase of care including the preoperative, intraoperative, and postoperative periods. Meticulous patient selection, tight glycemic control in diabetics, smoking cessation, and screening/eradication of Staphylococcus aureus are some of the main preoperative patient-related preventive strategies. Currently used intraoperative measures include alcohol-based skin preparation, topical vancomycin powder, and betadine irrigation of the surgical site before closure. Postoperative infection prophylaxis can be performed by administration of silver-impregnated or vacuum dressings, extended intravenous antibiotics, and supplemental oxygen therapy. Conclusions: Although preventive strategies are already in use alone or in combination, further high-level research is required to prove their efficacy in reducing the rate of SSIs in spine surgery before evidence-based standard infection prophylaxis guidelines can be built.

show abstract

Risk factors for surgical site infection in elective routine degenerative lumbar surgeries

Cited by 72 publications

References 35 publications

Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors

Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors

Effects of Operating Room Size on Surgical Site Infection Following Lumbar Fusion Surgery

Current Strategies in Prevention of Postoperative Infections in Spine Surgery

Contact Info

Product

Resources

About