Risk Factors for Surgical Site Infections Following Spinal Fusion Procedures: A Case-Control Study

Rao, Shilpa B.; Vásquez, Gustavo; Harrop, James S.; Maltenfort, Mitchell; Stein, Natalie; Kaliyadan, George; Klibert, Frank; Epstein, Richard H.; Sharan, Ashwini; Vaccaro, Alexander R.; Flomenberg, Phyllis

doi:10.1093/cid/cir506

Cited by 155 publications

(90 citation statements)

References 25 publications

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“…Rao et al found that male patients were at a higher risk for postoperative infections following spinal fusions, though this population included patients with trauma and malignancy, which carry different risks for infection than ASD patients. 14 Triebel et al observed that women undergoing lumbar fusion for degenerative disk disease had worse preoperative pain, disability, and quality of life than men, but we did not observe these outcomes in our ASD patients. However, in a similar finding to our study, the authors found that men and women had equivalent quality of life and returned to work 2 years after surgery.…”

Section: Discussioncontrasting

confidence: 91%

Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Bumpass

Lenke

Gum

et al. 2017

Neurosurgical Focus

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OBJECTIVEAdolescent spine deformity studies have shown that male patients require longer surgery and have greater estimated blood loss (EBL) and complications compared with female patients. No studies exist to support this relationship in adult spinal deformity (ASD). The purpose of this study was to investigate associations between sex and complications, deformity correction, and health-related quality of life (HRQOL) in patients with ASD. It was hypothesized that male ASD patients would have greater EBL, longer surgery, and more complications than female ASD patients.METHODSA multicenter ASD cohort was retrospectively queried for patients who underwent primary posterior-only instrumented fusions with a minimum of 5 levels fused. The minimum follow-up was 2 years. Primary outcomes were EBL, operative time, intra-, peri-, and postoperative complications, radiographic correction, and HRQOL outcomes (Oswestry Disability Index, SF-36, and Scoliosis Research Society-22r Questionnaire). Poisson multivariate regression was used to control for age, comorbidities, and levels fused.RESULTSNinety male and 319 female patients met the inclusion criteria. Male patients had significantly greater mean EBL (2373 ml vs 1829 ml, p = 0.01). The mean operative time, transfusion requirements, and final radiographic measurements did not differ between sexes. Similarly, changes in HRQOL showed no significant differences. Finally, there were no sex differences in the incidence of complications (total, major, or minor) at any time point after controlling for age, body mass index, comorbidities, and levels fused.CONCLUSIONSDespite higher EBL, male ASD patients did not experience more complications or require less deformity correction at the 2-year follow-up. HRQOL scores similarly showed no sex differences. These findings differ from adolescent deformity studies, and surgeons can counsel patients that sex is unlikely to influence the outcomes and complication rates of primary all-posterior ASD surgery.

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Section: Discussioncontrasting

confidence: 91%

Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Bumpass

Lenke

Gum

et al. 2017

Neurosurgical Focus

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“…Of the 34 articles that underwent full-text review, 12 [22][23][24][25][26][27][28][29][30][31][32][33] met eligibility criteria for inclusion in the meta-analysis and 22 were excluded. The most common reasons for exclusion of the 22 studies were: criteria for the diagnosis of SSI not reported and/or CDC/NNIS criteria not applied [34][35][36][37][38][39][40][41][42][43][44][45][46][47], non-scalar definitions of obesity used [47][48][49], risk estimates of the association between obesity/BMI and SSI not reported or raw data not provided to calculate risks [44,47,[50][51][52][53], and analyses restricted to deep wound infections [54,55].…”

Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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Purpose Inconsistent results have been reported in the literature on the association between obesity, expressed as increased body mass index (BMI), and risk for surgical site infection (SSI) following spine surgery. The objective of this study was to review and quantify the association between increased BMI and risk of spinal SSI in adults. Methods We performed a comprehensive search for relevant studies using PubMed, Embase, and references of published manuscripts. Study-specific risk measures were transformed into slope estimates and combined using the random effects meta-analysis model to establish the risk of SSI associated with every 5-unit increase in BMI. Results Thirty-four articles underwent full-text review. Variations were noted among these studies in relation to SSI diagnosis criteria and BMI cut-off levels used to define obesity. Data from 12 retrospective studies were included in the analyses. Results showed that BMI was significantly positively associated with the risk of spinal SSI. Unadjusted risk estimates demonstrated that a 5-unit increase in BMI was associated with 13 % increased risk of SSI [Crude odds ratio (OR): 1.13; 95 % CI: 1.07-1.19, p\ 0.0001]. Pooling of risk estimates adjusted for diabetes and other confounders resulted in a 21 % increase in risk of spinal SSI for every 5-unit increase in BMI (adjusted OR: 1.21; 95 % CI 1.13-1.29, p \ 0.0001). ConclusionHigher BMI is associated with the increased risk of SSI following spine surgery. Prospective studies are needed to confirm this association and to determine whether other measures of fat distribution are better predictors of risk of SSI.

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“…According to their multivariate analysis, this was one of the three factors predicting the probability of an infection, the others being blood transfusion and relevant past medical history [11]. A recent retrospective case control analysis of 57 patients with surgical site infections yielded a diametrically opposed conclusion; the analysis found that infected fusion procedures had a longer duration of closed suction drains by a mean of 5.1 days longer than the control [12].…”

Section: Introductionmentioning

confidence: 99%

Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire

2015

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Risk Factors for Surgical Site Infections Following Spinal Fusion Procedures: A Case-Control Study

Abstract: Prolonged duration of closed suction drains is a strong independent risk factor for SSI following instrumented spinal fusion procedures. Therefore, removing drains as early as possible may lower infection rates.

Cited by 155 publications

References 25 publications

Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire

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