Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery

Tominaga, Hiroyuki; Setoguchi, Takao; Kawamura, Hideki; Kawamura, Ichiro; Nagano, Satoshi; Abematsu, Masahiko; Tanabe, Fumito; Ishidou, Yasuhiro; Yamamoto, Takuya; Komiya, Setsuro

doi:10.1097/md.0000000000005118

Cited by 21 publications

(13 citation statements)

References 23 publications

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“…5,9,18,35 Prior studies have demonstrated SSI rates ranging widely from 0.7% to 10.0%, depending on the patient population, pathology, and type of procedure. 1,10,23,24,27,28,31,36 Unfortunately, large administrative registries lack the granularity to account for a number of perioperative and intraoperative variables that can affect the infection rate among institutions. In addition to patient characteristics and operative variables playing a role, the location of spine surgery also affects the rate of SSI, with thoracic (2.1%) and lumbar (1.6%) procedures more prone to SSI than cervical surgery (0.8%).…”

Section: Discussionmentioning

confidence: 99%

“…urgical site infection (SSI) is a problematic complication following spine surgery, with reported rates ranging from 0.7% to 10%. 10,23,24,27,28,31 The diagnosis and treatment of SSI can be difficult, and it frequently necessitates reoperation for wound debridement and/or instrumentation removal, prolonged hospitalization, and an extended antibiotic course. For these reasons, SSI remains a notable cause of postoperative morbidity, mortality, and high acuity of medical care, with treatment costs that range from $15,800 to $43,900.…”

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confidence: 99%

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Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Deng

Chan

Ammanuel

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVESurgical site infection (SSI) following spine surgery causes major morbidity and greatly impedes functional recovery. In the modern era of advanced operative techniques and improved perioperative care, SSI remains a problematic complication that may be reduced with institutional practices. The objectives of this study were to 1) characterize the SSI rate and microbial etiology following spine surgery for various thoracolumbar diseases, and 2) identify risk factors that were associated with SSI despite current perioperative management.METHODSAll patients treated with thoracic or lumbar spine operations on the neurosurgery service at the University of California, San Francisco from April 2012 to April 2016 were formally reviewed for SSI using the National Healthcare Safety Network (NHSN) guidelines. Preoperative risk variables included age, sex, BMI, smoking, diabetes mellitus (DM), coronary artery disease (CAD), ambulatory status, history of malignancy, use of preoperative chlorhexidine gluconate (CHG) showers, and the American Society of Anesthesiologists (ASA) classification. Operative variables included surgical pathology, resident involvement, spine level and surgical technique, instrumentation, antibiotic and steroid use, estimated blood loss (EBL), and operative time. Multivariable logistic regression was used to evaluate predictors for SSI. Odds ratios and 95% confidence intervals were reported.RESULTSIn total, 2252 consecutive patients underwent thoracolumbar spine surgery. The mean patient age was 58.6 ± 13.8 years and 49.6% were male. The mean hospital length of stay was 6.6 ± 7.4 days. Sixty percent of patients had degenerative conditions, and 51.9% underwent fusions. Sixty percent of patients utilized presurgery CHG showers. The mean operative duration was 3.7 ± 2 hours, and the mean EBL was 467 ± 829 ml. Compared to nonfusion patients, fusion patients were older (mean 60.1 ± 12.7 vs 57.1 ± 14.7 years, p < 0.001), were more likely to have an ASA classification > II (48.0% vs 36.0%, p < 0.001), and experienced longer operative times (252.3 ± 120.9 minutes vs 191.1 ± 110.2 minutes, p < 0.001). Eleven patients had deep SSI (0.49%), and the most common causative organisms were methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus. Patients with CAD (p = 0.003) or DM (p = 0.050), and those who were male (p = 0.006), were predictors of increased odds of SSI, and presurgery CHG showers (p = 0.001) were associated with decreased odds of SSI.CONCLUSIONSThis institutional experience over a 4-year period revealed that the overall rate of SSI by the NHSN criteria was low at 0.49% following thoracolumbar surgery. This was attributable to the implementation of presurgery optimization, and intraoperative and postoperative measures to prevent SSI across the authors’ institution. Despite prevention measures, having a history of CAD or DM, and being male, were risk factors associated with increased SSI, and presurgery CHG shower utilization decreased SSI risk in patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Deng

Chan

Ammanuel

et al. 2020

Journal of Neurosurgery: Spine

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“…In infected patients antibiotic therapy was continued for at least six weeks postoperatively and in case of MRSA recent recommendations suggest to extend intravenous antibiotic therapy for eight weeks (20). In all patients the hardware was titanium screws, rods or cervical plate known as safe also in patients with ongoing active infections (23,24). This characteristic is due to the difficulty of organisms to colonize the titanium material biofilm (3).…”

Section: Discussionmentioning

confidence: 99%

Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy

Dobran¹,

Marini²,

Gladi³

et al. 2017

GHIR

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“…Antibiotic therapy is administered for 6 to 12 weeks, depending on the isolate or isolates [16]. Instrumentation may be retained, replaced by autologous tricortical graft with anterior plate in early (< 1 month) infection, or removed in late infection with acquired fusion [17][18][19][20].…”

Section: Treatment Of Surgical Site Infectionmentioning

confidence: 99%

Anterior cervical spine surgical site infection and pharyngoesophageal perforation. Ten-year incidence in 1475 patients

Gamain

Coulomb

Houzir³

et al. 2019

Orthopaedics & Traumatology: Surgery & Research

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Background: Surgical site infection is reputed to be infrequent in anterior cervical spine surgery. Data on pathophysiological mechanism and risk factors are sparse. The relationship between local site infection and pharyngoesophageal perforation is unclear. The present study aimed: (1) to estimate the incidence of surgical site infection in anterior cervical spine surgery, (2) estimate the incidence of associated pharyngoesophageal perforation, and (3) suggest a decision-tree for early management of this twofold issue. Hypothesis: Although with very low incidence, anterior cervical spine surgical site infection and pharyn-goesophageal perforation are frequently associated. Material and methods: A 2-center retrospective study included all anterior cervical spine surgeries between January 1, 2007 and December 31, 2016. Data were provided by the two medical information departments. Patients undergoing anterior revision surgery on the cervical spine were included. Files were analyzed to determine whether the revision surgery was secondary to surgical site infection. Results: In total, 1475 patients with anterior cervical spine surgery were identified: 1180 in center A (80%) and 295 in center B (20%). The rate of revision surgery for surgical site infection was 0.34% (5/1475). There were 3 cases of pharyngoesophageal perforation (0.2%). Discussion: The incidence of revision surgery for anterior cervical spine surgical site infection was comparable to rates in the international literature (0.07-1.6%). An association between surgical site infection and pharyngoesophageal perforation was frequent, but not statistically significant. This complication is extremely serious, requiring urgent multidisciplinary management.

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Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery

Abstract: Supplemental Digital Content is available in the text

Cited by 21 publications

References 23 publications

Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy

Anterior cervical spine surgical site infection and pharyngoesophageal perforation. Ten-year incidence in 1475 patients

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