Association Between Surgeon Experience and Complication Rates in Adult Scoliosis Surgery

Skovrlj, Branko; Cho, Samuel K.; Caridi, John M.; Lenke, Lawrence G.; Kim, Yongjung J.

doi:10.1097/brs.0000000000000993

Cited by 21 publications

(13 citation statements)

References 55 publications

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“…In contrast to previous research on SSI, which generally focused on a wide variety of spinal procedures (e.g., instrumented fusion surgery) and diseases (e.g., spinal trauma and spinal tumor) [ 2 , 8 , 9 ], this study included only the patients with SSI following specific types of procedures and diseases (i.e., lumbar laminectomy and/or herniotomy for degenerative diseases) without metal implants. Second, this study did not account for several factors, including experience level of the surgeon [ 34 ] and malnutrition [ 3 ], which were described as risk factors for SSI in some studies. Although the measured confounders were adjusted by a multivariate analysis, the results may still be biased because of unmeasured confounders.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for surgical site infection after lumbar laminectomy and/or discectomy for degenerative diseases in adults: A prospective multicenter surveillance study with registry of 4027 cases

Ogihara

Yamazaki

Inanami³

et al. 2018

PLoS ONE

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Surgical site infection (SSI) is a significant complication after spinal surgery and is associated with increased hospital length of stay, high healthcare costs, and poor patient outcomes. Accurate identification of risk factors is essential to develop strategies to prevent wound infections. The aim of this prospective multicenter study was to determine the independent factors associated with SSI in posterior lumbar surgeries without fusion (laminectomy and/or herniotomy) for degenerative diseases in adult patients. From July 2010 to June 2014, we conducted a prospective multicenter surveillance study in adult patients who developed SSI after undergoing lumbar laminectomy and/or discectomy in ten participating hospitals. Detailed patient and operative characteristics were prospectively recorded using a standardized data collection format. SSI was based on the Centers for Disease Control and Prevention definition. A total of 4027 consecutive adult patients were enrolled, of which 26 (0.65%) developed postoperative SSI. Multivariate regression analysis indicated two independent factors. An operating time >2 h (P = 0.0095) was a statistically significant independent risk factor, whereas endoscopic tubular surgery (P = 0.040) was a significant independent protective factor. Identification of these associated factors may contribute to surgeons’ awareness of the risk factors for SSI and could help counsel the patients on the risks associated with lumbar laminectomy and/or discectomy. Furthermore, this study’s findings could be used to develop protocols to decrease SSI risk. To the best of our knowledge, this is the first prospective multicenter study that identified endoscopic tubular surgery as an independent protective factor against SSI after lumbar posterior surgery without fusion.

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Section: Discussionmentioning

confidence: 99%

Risk factors for surgical site infection after lumbar laminectomy and/or discectomy for degenerative diseases in adults: A prospective multicenter surveillance study with registry of 4027 cases

Ogihara

Yamazaki

Inanami³

et al. 2018

PLoS ONE

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“…Only 1 study has looked at surgeon experience in relation to SSI, with Skovrlj et al 84 finding that in adult scoliosis surgery, candidate members as compared with active members for the Scoliosis Research Society had a 2-fold increase in the rate of superficial, though not deep, SSI which was statistically significant. In regards to the effect of resident involvement and experience, 3 studies looking at different aspects of this have found an association with SSI.…”

Section: Surgery-associated Risk Factorsmentioning

confidence: 99%

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

Yao

Zhou

Choma

et al. 2018

Global Spine Journal

105

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Study Design:Retrospective literature review of spine surgical site infection (SSI).Objective:To perform a review of SSI risk factors and more specifically, categorize them into patient and surgical factors.Methods:A review of published literature on SSI risk factors in adult spine surgery was performed. We included studies that reported risk factors for SSI in adult spinal surgery. Excluded are pediatric patient populations, systematic reviews, and meta-analyses. Overall, we identified 72 cohort studies, 1 controlled-cohort study, 1 matched-cohort study, 1 matched-paired cohort study, 12 case-controlled studies (CCS), 6 case series, and 1 cross-sectional study.Results:Patient-associated risk factors—diabetes mellitus, obesity (body mass index >35 kg/m2), subcutaneous fat thickness, multiple medical comorbidities, current smoker, and malnutrition were associated with SSI. Surgical associated factors—preoperative radiation/postoperative blood transfusion, combined anterior/posterior approach, surgical invasiveness, or levels of instrumentation were associated with increased SSI. There is mixed evidence of age, duration of surgery, surgical team, intraoperative blood loss, dural tear, and urinary tract infection/urinary catheter in association with SSI.Conclusion:SSIs are associated with many risk factors that can be patient or surgically related. Our review was able to identify important modifiable and nonmodifiable risk factors that can be essential in surgical planning and discussion with patients.

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“…The risk of intraoperative complications declined with increasing surgical experience. Skovrlj et al9 evaluated surgeon experience for perioperative complications in patients who underwent adult scoliosis surgery. The incidence of spinal cord complications and surgical site infection seemed to be different between the candidate members and active members of the Scoliosis Research Society.…”

Section: Discussionmentioning

confidence: 99%

Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn

Vaidyanathan

Samsudin

Singh³

et al. 2016

IMCRJ

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IntroductionParaplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case.Case reportA 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure). Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT) of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30% to 17%. Follow-up CT revealed reduction in the size of subcapsular hematoma, no hydronephrosis, and several residual calculi.ConclusionRisk of subcapsular hematoma following ureteroscopic lithotripsy can be reduced by avoiding prolonged endoscopy and performing ureteroscopy under low pressure. When a paraplegic patient develops features of infection after ureteroscopy, renal imaging should be carried out promptly. Extended perioperative medical care is required for spinal cord injury patients because of their propensity to develop sepsis. Antibiotics should be prescribed on the basis of recent urine microbiology results. Spinal cord injury patients should be treated by senior, experienced doctors and cared for in a spinal injuries unit in order to minimize complications.

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Association Between Surgeon Experience and Complication Rates in Adult Scoliosis Surgery

Abstract: 4.

Cited by 21 publications

References 55 publications

Risk factors for surgical site infection after lumbar laminectomy and/or discectomy for degenerative diseases in adults: A prospective multicenter surveillance study with registry of 4027 cases

Risk factors for surgical site infection after lumbar laminectomy and/or discectomy for degenerative diseases in adults: A prospective multicenter surveillance study with registry of 4027 cases

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

Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn

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