Surgical Site Infections After Posterior Spinal Fusion for Neuromuscular Scoliosis

Ramo, Brandon; Roberts, David W.; Tuason, Dominick; McClung, Anna; Paraison, Lauren; Moore, Harold E.; Sucato, Daniel J.

doi:10.2106/jbjs.n.00277

Cited by 115 publications

(103 citation statements)

References 21 publications

(24 reference statements)

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“…The pooled average SSI rate was calculated to be 1.9% (median, 3.3%; range, 0.1%–22.6%) based on 196 different study cohorts (some studies had more than one cohort). Among these studies, 29 classified SSIs according to the time of onset following the index procedure [11,13,15,20,22,25,32,37,54,56,66,78,82–84,86,95,117,132,142,144,147,154,156,160,164,167,170,171]. The majority of studies used the more common Tsukayama et al [172] classification system, in which acute (early) infections occur within one month of the index procedure and chronic (late) infections occur more than one month after the index procedure.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies used the more common Tsukayama et al [172] classification system, in which acute (early) infections occur within one month of the index procedure and chronic (late) infections occur more than one month after the index procedure. The pooled average early SSI rate among 14,517 patients was 2.1% (median, 2.6%; range, 0.5%–16.7%) [11,13,20,22,25,32,78,82–84,86,142,147,156,164,167,170,171] compared with 0.8% (median, 0.9%; range, 0.1%–4.7%) for pooled average late SSI rate among 12,238 patients [11,13,54,83,167,171]. In terms of specific types of spine operations, 52 studies evaluated SSI rates among patients who underwent spinal fusion [9,10,14,15,21,24,27,30,33,42,43,46,52,56,58,62,63,68–70,72,75,76,92,103,105,107–109,111,113–115,119,120,123,125,128,133,139,141–144,146,150,151,157,161,162,164,173].…”

Section: Resultsmentioning

confidence: 99%

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Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

View full text Add to dashboard Cite

show abstract

“…However, the use of a drain is recommended for all routine closures. While current research is equivocal with respect to the use of drains following deformity correction, Ramo et al [21] report significant protective effects thereof in patients without spina bifida. Furthermore, the use of drains was found to be useful in patients with NMS requiring multiple surgical debridements [5].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis

et al. 2019

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Objective: This study aims to elucidate surgical risk factors in neuromuscular scoliosis (NMS) with respect to wound site infection after spinal fusion. Methods: A retrospective review was performed of all patients treated surgically for NMS between January 2008 and December 2016 (minimum 6 months’ follow-up). A sub-cohort of 60 patients with minimum 2 years of follow-up data was also analyzed. Results: In 102 patients (53 boys and 49 girls), the mean age at surgery was 14.0 years (SD ±2.7). Mean follow-up was 2.53 years (±1.66), and mean time to presentation of infection was 2.14 months (±4.95). The overall perioperative complication rate was 26.5%, with 14.7% of patients developing deep wound infection. Gram-negative bacteria were responsible for 60% of infections; 20% were Gram positive, and 20% involved both types. Pulmonary comorbidities (p = 0.007), pre- to postoperative increase in weight (p = 0.010), exaggerated lumbar lordosis at follow-up (p = 0.008), history of seizures (p = 0.046), previous myelomeningocele repair (p = 0.046), and previous operations (p = 0.013) were significant risk factors for infection. Conclusion: Our data suggest that in the pediatric population treated surgically for NMS, wound infection is strongly associated with postoperative increase in body weight, residual lumbar lordosis, pulmonary comorbidity, history of myelomeningocele repair, seizures, and previous operations.

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“…Another interesting commonality is that bleeding or clotting complications (Figure 2b), medical complications (Figure 2d), and other complications (Figure 2e) share the feature that measures hemoglobin (HGB) maximum lab value as one of the top 2 largest decreasing features. This suggests that hemoglobin (HGB) maximum lab value could be a feature to help predict HAC within the first 18 hours 31–35 . This data supports the notion that the first 24 hours of a critical illness admission are crucial and that excessive handoffs during this period are likely to be problematic 36 .…”

Section: Discussionmentioning

confidence: 99%

Classification of hospital acquired complications using temporal clinical information from a large electronic health record

Warner

Zhang

Liu

et al. 2016

Journal of Biomedical Informatics

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Hospital Acquired Complications (HACs) are serious problems affecting modern day healthcare institutions. It is estimated that HACs result in an approximately 10% increase in total inpatient hospital costs across US hospitals. With US hospital spending totaling nearly $900 billion per annum, the damages caused by HACs are no small matter. Early detection and prevention of HACs could greatly reduce strains on the US healthcare system and improve patient morbidity & mortality rates. Here, we describe a machine-learning model for predicting the occurrence of HACs within five distinct categories using temporal clinical data. Using our approach, we find that at least $10 billion of excessive hospital costs could be saved in the US alone, with the institution of effective preventive measures. In addition, we also identify several keystone features that demonstrate high predictive power for HACs over different time periods following patient admission. The classifiers and features analyzed in this study show high promise of being able to be used for accurate prediction of HACs in clinical settings, and furthermore provide novel insights into the contribution of various clinical factors to the risk of developing HACs as a function of healthcare system exposure.

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Surgical Site Infections After Posterior Spinal Fusion for Neuromuscular Scoliosis

Abstract: This study identified modifiable factors, especially antibiotic dosing and drain use, associated with surgical site infection in patients with neuromuscular scoliosis.

Cited by 115 publications

References 21 publications

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis

Classification of hospital acquired complications using temporal clinical information from a large electronic health record

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