2012 Young Investigator Award Winner

Mehta, Ankit I.; Babu, Ranjith; Karikari, Isaac O.; Grunch, Betsy H.; Agarwal, Vijay; Owens, Timothy R.; Friedman, Allan H.; Bagley, Carlos A.; Gottfried, Oren N.

doi:10.1097/brs.0b013e318241b186

Cited by 148 publications

(50 citation statements)

References 26 publications

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“…The use of subcutaneous drains to prevent dead space or recommending weight loss preoperatively may be effective strategies for preventing SSI. Although the different cutoffs (BMI [30 or BMI [35) or different definitions for obesity were utilized in different studies, the influence of obesity on SSI showed a similar trend. Therefore, weight loss may lower risk of SSI after spinal surgery.…”

Section: Discussionmentioning

confidence: 75%

“…Although longer operative times were dictated mostly by the surgical complexity of the procedure, they can be mitigated by factors such as the proficiency of the surgeon and the operation methods [32]. The proper methods, which can minimize tissue necrosis and decrease infection rates, include releasing the tension on self-retractors often [49] and frequent irrigation of the Number of spinal levels operated 229 [1,50] 3 9 [ 28,35] Surgery involving the sacrum or pelvis 297 [1,33] Larger intraoperative blood loss 216 [26,42] 3 1 [ 12,61] Surgery with spinal instrumentation 856 [33,56] 127 [12,24,27,28,58] Previous surgery 52 [10,50] Blood transfusions 752 [56] 6 1 [ 52] ASA classification 856 [33,56] Limited evidence Hypertension 63 [13] Invasiveness index 63 [13] Renal disease 63 [13] Bony or connective tissue neoplasm 193 [1] Skin to lamina distance 24 [35] Thickness of subcutaneous fat 24 [35] Surgical case order Presence of comorbidities 139 [8,26] Preoperative irradiation 8 [14] Exposure to razor shaving 104 [33] Intraoperative administration of a F i O 2 less than 50 % 104 [33] Suboptimal timing of prophylactic antibiotic therapy 56 [40] Pre-/post-operative elevated serum glucose level 56 [40] 6 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

Xing

et al. 2012

Eur Spine J

137

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Objective To identify the independent risk factors, based on available evidence in the literature, for patients developing surgical site infections (SSI) after spinal surgery. Methods Non-interventional studies evaluating the independent risk factors for patients developing SSI following spinal surgery were searched in Medline, Embase, Sciencedirect and OVID. The quality of the included studies was assessed by a modified quality assessment tool that had been previously designed for observational studies. The effects of studies were combined with the study quality score using a best-evidence synthesis model. Results Thirty-six observational studies involving 2,439 patients with SSI after spinal surgery were identified. The included studies covered a wide range of indications and surgical procedures. These articles were published between 1998 and 2012. According to the quality assessment criteria for included studies, 15 studies were deemed to be high-quality studies, 5 were moderate-quality studies, and 16 were low-quality studies. A total of 46 independent factors were evaluated for risk of SSI. There was strong evidence for six factors, including obesity/BMI, longer operation times, diabetes, smoking, history of previous SSI and type of surgical procedure. We also identified 8 moderate-evidence, 31 limited-evidence and 1 conflictingevidence factors. Conclusion Although there is no conclusive evidence for why postoperative SSI occurs, these data provide evidence to guide clinicians in admitting patients who will have spinal operations and to choose an optimal prophylactic strategy. Further research is still required to evaluate the effects of these above risk factors.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

Xing

et al. 2012

Eur Spine J

137

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“…The pooled average SSI rate was calculated to be 1.6% (median, 2.8%; range, 0.2%–18.3%) based on 64 cohorts comprising a total of 212,639 patients. Patients who underwent instrumented spinal fusion procedures were evaluated for SSIs in 35 identified studies [6,12,25,28,35,37,39,48,50,61,67,74,77,78,84,85,90,93,97,98,101,112,121,122,126,127,132,134,135,137,148,154,156,160,174]. The pooled average SSI rate was calculated to be 3.8% (median, 4.2%; range, 0.4%–20%) based on 39 cohorts with a total of 28,628 patients.…”

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

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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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“…Lumbar microdiscectomy usually involved a longer incision than usual in obese patients11). Retraction was difficult and visualization of the important elements of the operation was obscured by the patient's depth4). This study was performed to evaluate outcomes after lumbar microdiscectomy in patient who are obese.…”

Section: Discussionmentioning

confidence: 99%

Does Obesity Make an Influence on Surgical Outcomes Following Lumbar Microdiscectomy?

et al. 2014

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ObjectiveThe purpose of this study was to evaluate the effect of patients' bod mass index (BMI) on surgical outcomes following one-level lumbar microdiscectomy.MethodsFrom June 2003 to March 2007, 129 patients underwent one-level lumbar microdiscectomy performed at a single institution. We divided the patients into 3 groups, depending on BMI. A retrospective study was conducted among the 3 groups. The operation time, estimated blood loss (EBL), postoperative hospital day, recurrent disc herniation, intraoperative durotomy, and postoperative epidural steroid injection were analyzed. Regression models were used to predict the relationship between BMI and surgical outcomes including operation time and EBL.ResultsAs BMI is greater, as the operation time is longer and the EBL is more. In particular, linear regression model analysis implied that 2.35 minute in the operation time is longer and 8.89cc in EBL is more, as BMI of 1 kg/m2 is increased. No statistically relevant differences were observed for postoperative hospital day, recurrent disc herniation, intraoperative durotomy, and postoperative epidural steroid injection.ConclusionThe operation time and EBL was significantly increased in obesity, but there were no differences in surgical outcomes. Our results demonstrated that higher BMI are not likely to encounter heightened morbidity in lumbar microdiscectomy.

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2012 Young Investigator Award Winner

Abstract: Our findings suggest that in obese patients, the distribution of body mass is more predictive of SSI than the absolute BMI and deserves attention in preoperative evaluation.

Cited by 148 publications

References 26 publications

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

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

Does Obesity Make an Influence on Surgical Outcomes Following Lumbar Microdiscectomy?

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