Thickness of Subcutaneous Fat as a Risk Factor for Infection in Cervical Spine Fusion Surgery

Mehta, Ankit I.; Babu, Ranjith; Sharma, Richa; Karikari, Isaac O.; Grunch, Betsy H.; Owens, Timothy R.; Agarwal, Vijay; Sampson, John H.; Lad, Shivanand P.; Friedman, Allan H.; Kuchibhatla, Maragatha; Bagley, Carlos A.; Gottfried, Oren N.

doi:10.2106/jbjs.l.00225

Cited by 96 publications

(90 citation statements)

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“…Five additional potentially relevant studies were identified from reference lists. 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%

“…Waisbren et al [12], found a quadratic non-linear relationship between BMI and % BF, while Mehta et al [27] found no significant correlation between BMI and the thickness of subcutaneous fat measured at the level of L4 in adult patients undergoing lumbar surgery. Thickness of subcutaneous fat and % BF were shown to be significant risk factors for SSI while BMI was not [12,27,28]. Therefore, measures of fatness other than BMI may serve as better predictors of SSI.…”

Section: Odds Ratiomentioning

confidence: 98%

“…Results from the Spine Patient Outcomes Research Trial (SPORT) showed a non-significant difference in wound infection rates between the obese and nonobese cohorts undergoing surgical treatment for lumbar disc herniation [11]. Mehta et al [27,28] showed that BMI was not significantly associated with SSI in patients who underwent posterior lumbar fusion or cervical fusion surgeries. The authors demonstrated that the thickness of subcutaneous fat at the surgical site is more indicative of SSI risk than absolute BMI.…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, Waisbren et al [12] showed that obesity measured by percent body fat (% BF) was associated with more than 59 higher risk of postoperative SSI, while obesity measured by BMI was not a risk factor for SSI. These results led to the proposition that measures of adiposity other than BMI, such as % BF and thickness of subcutaneous fat, are more sensitive measurements of the risk of SSI than BMI-defined obesity [12,27,28].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Section: Odds Ratiomentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2013

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“…Mehta et al reported an association between subcutaneous fat thickness (SFT) and SSIs after posterior cervical spine fusion surgery, this being an independent risk factor [10]. In the cervical area, there usually is a distinct layer of well-perfused musculature between the skin and spine.…”

mentioning

confidence: 99%

Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Osterhoff

Burla

Werner

et al. 2015

Surgical Infections

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BACKGROUND Surgical site infections (SSIs) increase morbidity and mortality rates and generate additional cost for the healthcare system. Pre-operative blood transfusion and the subcutaneous fat thickness (SFT) have been described as risk factors for SSI in other surgical areas. The purpose of this study was to assess the impact of pre-operative blood transfusion and the SFT on the occurrence of SSI in posterior thoracic spine surgery. METHODS In total, 244 patients (median age 55 y; 97 female) who underwent posterior thoracic spine fusions from 2008 to 2012 were reviewed retrospectively. Patientspecific characteristics, pre-operative hemoglobin concentration/hematocrit values, the amount of blood transfused, and the occurrence of a post-operative SSI were documented. The SFT was measured on pre-operative computed tomography scans. RESULTS Surgical site infection was observed in 26 patients (11%). The SFT was 13 mm in patients without SSI and 14 mm in those with infection (p=0.195). The odds ratio for patients with pre-operative blood transfusion to present with SSI was 3.1 (confidence interval [CI] 1.4-7.2) and 2.7 (CI 1.1-6.4) when adjusted for age. There was no difference between the groups with regard to pre-operative hemoglobin concentration (p=0.519) or hematocrit (p=0.908). The SFT did not differ in the two groups. CONCLUSIONS Allogeneic red blood cell transfusion within 48 h prior to surgery was an independent risk factor for SSI after posterior fusion for the fixation of thoracic spine instabilities. Pre-operative blood transfusion tripled the risk, whereas SFT had no influence on the occurrence of SSI. Background: Surgical site infections (SSIs) increase morbidity and mortality rates and generate additional cost for the healthcare system. Pre-operative blood transfusion and the subcutaneous fat thickness (SFT) have been described as risk factors for SSI in other surgical areas. The purpose of this study was to assess the impact of pre-operative blood transfusion and the SFT on the occurrence of SSI in posterior thoracic spine surgery. Methods: In total, 244 patients (median age 55 y; 97 female) who underwent posterior thoracic spine fusions from 2008 to 2012 were reviewed retrospectively. Patient-specific characteristics, pre-operative hemoglobin concentration/hematocrit values, the amount of blood transfused, and the occurrence of a post-operative SSI were documented. The SFT was measured on pre-operative computed tomography scans.Results: Surgical site infection was observed in 26 patients (11%). The SFT was 13 mm in patients without SSI and 14 mm in those with infection (p = 0.195). The odds ratio for patients with pre-operative blood transfusion to present with SSI was 3.1 (confidence interval [CI] 1.4-7.2) and 2.7 (CI 1.1-6.4) when adjusted for age. There was no difference between the groups with regard to pre-operative hemoglobin concentration (p = 0.519) or hematocrit (p = 0.908). The SFT did not differ in the two groups. Conclusions: Allogeneic red blood cell transfusion within 48 h p...

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Deep Wound and Organ-Space Infection After Surgery for Degenerative Spine Disease

Ramhmdani

Bydon

2017

Burns, Infections and Wound Management

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Thickness of Subcutaneous Fat as a Risk Factor for Infection in Cervical Spine Fusion Surgery

Abstract: The study demonstrated that the thickness of subcutaneous fat at the surgical site is a factor in the development of surgical site infection following cervical spine fusion and deserves assessment in the preoperative evaluation.

Cited by 96 publications

References 18 publications

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

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

Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Deep Wound and Organ-Space Infection After Surgery for Degenerative Spine Disease

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