Risk factors for surgical site infection in spinal surgery. J Neurosurg Spine

Division of Infectious Diseases and Neurosurgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 03/2003; 98(2 Suppl):149-55. DOI: 10.3171/spi.2003.98.2.0149
Source: PubMed


The objective of this study was to identify specific independent risk factors for surgical site infections (SSIs) occurring after laminectomy or spinal fusion.
The authors performed a retrospective case-control study of data obtained in patients between 1996 and 1999 who had undergone laminectomy and/or spinal fusion. Forty-one patients with SSI or meningitis were identified, and data were compared with those acquired in 178 uninfected control patients. Risk factors for SSI were determined using univariate analyses and multivariate logistic regression. The spinal surgery-related SSI rate (incisional and organ space) during the 4-year study period was 2.8%. Independent risk factors for SSI identified by multivariate analysis were postoperative incontinence (odds ratio [OR] 8.2, 95% confidence interval [CI] 2.9-22.8), posterior approach (OR 8.2, 95% CI 2-33.5), procedure for tumor resection (OR 6.2, 95% CI 1.7-22.3), and morbid obesity (OR 5.2, 95% CI 1.9-14.2). In patients with SSI the postoperative hospital length of stay was significantly longer than that in uninfected patients (median 6 and 3 days, respectively; p < 0.001) and were readmitted to the hospital for a median additional 6 days for treatment of their infection. Repeated surgery due to the infection was required in the majority (73%) of infected patients.
Postoperative incontinence, posterior approach, surgery for tumor resection, and morbid obesity were independent risk factors predictive of SSI following spinal surgery. Interventions to reduce the risk for these potentially devastating infections need to be developed.

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    • ". Several studies on infection after surgery for spinal tumors have focused on risk factors, and this discussion is beyond our article [13] [14] [15] [16] [17]. "
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    ABSTRACT: BACKGROUND CONTEXT: The surgical treatment in spinal metastases has been shown to improve function and neurological outcome. Unplanned hospital readmissions can be costly and cause unnecessary harm. PURPOSE: Our aim was to firstly analyse the re-operation rate and indications for this revision surgery in spinal metastases from an academic tertiary spinal institute and secondly, to make comparisons on outcome (neurology and survival) against patients who underwent single surgery only. STUDY DESIGN/SETTING: An ambispective review of all patients treated surgically over 8 year period considering their neurological and survival outcome data. Statistical analysis was performed using IBM SPSS 20. Since all scale values did not follow the normal distribution and significant outlier values existed, all descriptive statistics and comparisons were made using median values and the Median test. Crosstabs and Pearson's correlation were used to calculate differences between percentages and ordinal/ nominal values. For two population proportions the Z Test was used to calculate differences. The Log Rank Mantel-Cox analysis was used to compare survival. PATIENT SAMPLE: During the 8 years' study period, there were 384 patients who underwent urgent surgery for spinal metastasis. Of these, 289 patients were included who had sufficient information available. There were 31 re-operations performed (10.7%; mean age 60 years; 13M, 18F). Exclusion criteria included patients treated solely by radiotherapy, patients who had undergone surgery for spinal metastasis prior to the study period and those patients who had other causes for neurological dysfunction such as stroke. OUTCOME MEASURES: Revised Tokuhashi score, preoperative/postoperative Frankel scores and survival. METHODS: We performed an ambispective review of all patients treated surgically from our comprehensive database during the study period (October 2004-October 2012). We reviewed all patient records held on the database, including patient demographics and re-operation rates. RESULTS: During the 8 years' study period, there were 31 re-operations performed (10.7%; mean age 60 years; 13M, 18F) in the 289 patients. Re-operations were performed in the same admission in the majority of patients (20), whilst 11 patients had their second procedure in subsequent hospitalisation. The reasons for their revision surgery were as follows: Surgical Site Infection (SSI) [13/31, (42%)], failure of instrumentation [9/31, (29%)], local recurrence [5/31, (16%)], haematoma evacuation [2/31, (6%)] and others [2/31, (6%)]. When comparing the 'Single Surgery' and 'Revision Surgery' groups, we found that the median preoperative and postoperative Frankel scores were similar at grade 4 (range: 1- 5) for both groups (preoperative p= 0.92, postoperative p=0.87). However, 20 (8%) patients from the Single surgery group and 7 (23%) from the Revision group had a worse postoperative score and this was significantly different (p=0.01). No significant difference was found (p=0.66) in the revised Tokuhashi score. The median number of survival days was similar (p=0.719) - Single Surgery Group (250 days, range: 5- 2597) and Revision Group (215 days, range: 9-1352). CONCLUSION: There was a modest re-operation rate (10.7%) in our patients treated surgically for spinal metastases over an 8 year period. Most of these were for SSI (42%), failure of instrumentation (26%) and local recurrence (16%). Patients with metastatic disease could benefit from revision surgery with comparable median survival rates but relatively poorer neurological outcomes. This study may help to assist with informed decision making for this vulnerable patient group.
    Full-text · Article · Jan 2015 · Spine
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    • "Ten studies considered risk factors describing patient dependence and frailty, which were characterized in a variety of ways, including independence and activities of daily living[14,15,25–27], incontinence[15,25,28], and admission from a long-term health-care facility[14,27]. The majority of these factors were only considered in unadjusted analyses; adjusted estimates include an odds ratio for SSI of 4.35 (95% CI: 1.64-11.11) "
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    ABSTRACT: Surgical site infection (SSI) complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus) is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally. The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting. An initial search identified 328 titles published in 2002-2012; 57 were identified as relevant for data extraction. Extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses. Median SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor-related and transplant surgeries. Median time until SSI onset was 17.0 days, with longer time-to-onset for orthopedic and transplant surgeries. Risk factors consistently identified as associated with SSI included co-morbidities, advanced age, risk indices, patient frailty, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analysis; 85% found a significant association with SSI, with odds ratios ranging from 1.5-24.3. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results. In a broad review of published literature, risk factors for SSI were characterized as describing reduced fitness, patient frailty, surgery duration, and complexity. Recognition of risk factors frequently associated with SSI allows for identification of such patients with the greatest need for optimal preventive measures to be identified and pre-treatment prior to surgery.
    Full-text · Article · Dec 2013 · PLoS ONE
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    • "It was already proved by several researchers that longer surgical times lead to higher infection rates [18-21]. We would like to investigate the quantitative correlation between the degree of contamination and the elapsed time. "
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    ABSTRACT: Prospective experimental study. To evaluate bacterial contamination during surgery. The participants of surgery and ventilation system have been known as the most significant sources of contamination. Two pairs of air culture blood agar plate for G(+) bacteria and MacConkey agar plate for G(-) bacteria were placed at 3 different locations in a conventional operation room: in the surgical field, under the airflow of local air conditioner, and pathway to door while performing spine surgeries. One pair of culture plates was retrieved after one hour and the other pair was retrieved after 3 hours. The cultured bacteria were identified and number of colonies was counted. There was no G(-) bacteria identified. G(+) bacteria grew on all 90 air culture blood agar plates. The colony count of one hour group was 14.5±5.4 in the surgical field, 11.3±6.6 under the local air conditioner, and 13.1±8.7 at the pathway to the door. There was no difference among the 3 locations. The colony count of 3 hours group was 46.4±19.5, 30.3±12.9, and 39.7±15.2, respectively. It was more at the surgical field than under the air conditioner (p=0.03). The number of colonies of one hour group was 13.0±7.0 and 3 hours group was 38.8±17.1. There was positive correlation between the time and the number of colonies (r=0.76, p=0.000). Conventional operation room was contaminated by G(+) bacteria. The degree of contamination was most high at the surgical field. The number of bacteria increased right proportionally to the time.
    Full-text · Article · Mar 2013 · Asian spine journal
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