The incidence and risk factors for surgical site infection after clean spinal operations: A prospective cohort study and review of the literature

Abstract

Background:Postoperative infection is one of the most common complications after spine surgeries. In our study, surgical site infection (SSI) is described as; superficial (i.e., skin and subcutaneous tissues) and deep (i.e., fascia and muscles) infections occurring in the short term (i.e., 1-month) after spine surgeries (Centers for Disease Control and Prevention definition 81.00–81.08). To detect the risk factors for the occurrence of such a complication, studies require a large number of patients, a high quality of data and adequate analysis. In this study, we prospectively enrolled 987 patients undergoing spinal surgery over a 3 years period.Methods:From November 2010 to November 2013, 987 patients had a variety of spinal operations that included; disc herniation, spinal stenosis, spondylolisthesis, fracture-dislocations, spine and spinal cord tumors, and syringomyelia. Patients under the age of 10, those with a recent history of infection and antibiotherapy, and patients with immunodeficiency disorders were excluded.Results:Of the 987 spine procedures performed, 27 (2.73%) developed postoperative infections. Multi-variant data analysis indicated that multiple factors correlated with an increased risk of SSI in descending order; trauma, a past history of diabetes, smoking, being confined to bed, in the perioperative period, mean blood sugar levels above 120 mg/dl, longer lengths of incisions, and longer hospital stay.Conclusion:Considering the preventable nature of most of the factors contributing to SSI, it should be possible to reduce these complications.

<p>The Impacts of Deep Surgical Site Infections on Readmissions, Length of Stay, and Costs: A Matched Case–Control Study Conducted in an Academic Hospital in the Netherlands</p>

“…55 Reported SSI rates for clean surgeries ranged between 0% and 3%. 14,56 The incidence of SSI in clean-contaminated surgeries is reported to range between 3% and 11%, 13,14 while the SSI rate for contaminated surgeries is approximately 15% of all surgical procedures. 14 Additionally, a high SSI rate of at least 20% has been reported for laparoscopies performed in cases of perforated appendicitis, which are considered dirty surgeries.…”

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

“…Only 1 study had a thoracic subgroup analysis for approach, with Olsen et al 64 finding a posteriorly only approach to be associated with SSI as compared anterior alone. For the most part, those studies that have not found an association 11,22,52,65,68,71,75,77 have included a combination of cervical, thoracic, and lumbar procedures, which may confound the significance of approach given that the relative risk of an anterior versus posterior approach is different at various spinal levels. In those studies showing approach to be a risk factor for SSI, 1,4,25,28,30,31,34,46,54,64 the general trend is for a combined anterior-posterior approach to have the highest risk for SSI, followed by a posterior approach, with the anterior approach often reducing the risk for SSI.…”

Management der frühen postoperativen Wundinfektion

“…Nebenerkrankungen und Trauma führt zu einer Erhöhung des postoperativen Wundinfektionsrisikos [9]. Während die Entstehung der Infektion auch bei Gelenkinfektionen den gleichen pathophysiologischen Prinzipien unterliegt, ist durch die anatomisch präformierte Höhle des Gelenkraums jedoch eine besondere Situation vorhanden.…”