Surgical Site Infection in Spine Surgery: Who Is at Risk?

Abstract

Study Design:Retrospective literature review of spine surgical site infection (SSI).Objective:To perform a review of SSI risk factors and more specifically, categorize them into patient and surgical factors.Methods:A review of published literature on SSI risk factors in adult spine surgery was performed. We included studies that reported risk factors for SSI in adult spinal surgery. Excluded are pediatric patient populations, systematic reviews, and meta-analyses. Overall, we identified 72 cohort studies, 1 controlled-cohort study, 1 matched-cohort study, 1 matched-paired cohort study, 12 case-controlled studies (CCS), 6 case series, and 1 cross-sectional study.Results:Patient-associated risk factors—diabetes mellitus, obesity (body mass index >35 kg/m2), subcutaneous fat thickness, multiple medical comorbidities, current smoker, and malnutrition were associated with SSI. Surgical associated factors—preoperative radiation/postoperative blood transfusion, combined anterior/posterior approach, surgical invasiveness, or levels of instrumentation were associated with increased SSI. There is mixed evidence of age, duration of surgery, surgical team, intraoperative blood loss, dural tear, and urinary tract infection/urinary catheter in association with SSI.Conclusion:SSIs are associated with many risk factors that can be patient or surgically related. Our review was able to identify important modifiable and nonmodifiable risk factors that can be essential in surgical planning and discussion with patients.

A retrospective analysis of factors affecting surgical site infection in orthopaedic patients

“…These factors have been demonstrated previously to be risk factors for SSI. 13,41,42 Finally, patients were not classified as deep/superficial/organ space since these classifications were not commonly used in the study setting.…”

Risk factors of health care–associated infection in elderly patients: a retrospective cohort study performed at a tertiary hospital in China

“…The relationship between patient age and the risk of SSI is not consistently reported in the literature, with numerous studies that implicating advanced age as a risk factor for SSI, and numerous studies finding no such association. Although SSI is one of the complications causing poor prognosis postoperative patients, the incidence is reported to vary from 0.1 to 50% [24, 25]. But general incidence of SSI of the most operations is lower than the common HAIs such as pneumonia, urinary tract infection and blood stream infection, especially in elderly.…”

The risk factors of surgical site infection following posterior cervical spine surgery

“…Current evidence demonstrates a strong and independent association between malnutrition and infectious and wound complications following posterior cervical spine surgeries 15,16 . Our results support the use of laboratory nutritional screening as a component of preoperative patient assessment and optimization to solve the di culty of assessment of nutritional status of different people.…”

“…Although advances have been made in infection control practices, the incidence of SSI after posterior cervical surgery ranges from 1.3-14%, Several risk factors for SSI in posterior cervical spine surgeries are increasingly being investigated. Many estimated risk factors have been reported in previous studies, such as advanced age, higher body mass index (BMI > 30 kg/m 2 ), smoking, diabetes, malnutrition (preoperative albumin level < 3.5 g/dL), history of infection in the surgical site, preoperative steroid therapy, blood loss, implant, and prolonged operative time (> 3 hours) [11][12][13][14][15][16] . Meanwhile, bacterial culture indicated that the most common causative microorganisms of SSI in spinal surgery are Staphylococcus aureus and other members of Staphylococcus species 17,18 .…”