Complications related to instrumentation in spine surgery: a prospective analysis

Campbell, Peter G.; Yadla, Sanjay; Malone, Jennifer; Maltenfort, Mitchell; Harrop, James S.; Sharan, Ashwini; Ratliff, John K.

doi:10.3171/2011.7.focus1134

Cited by 59 publications

(35 citation statements)

References 31 publications

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“…Instrumentation failure occurred in 8.2% of cases and pseudoarthrosis (assessed independently by a radiologist) in 2.4%. Instrumentation failure rates in the present study, however, were found to be greater in the setting of an infection compared with noninfection settings, in which rates approximate 2% (6). Pseudoarthrosis, in contrast, was only 2.4% compared with reported rates of 17%e24% in the literature (19,20), a phenomenon that has been attributed to "spontaneous" fusion in the setting of a spinal infection (3).…”

Section: Key Resultscontrasting

confidence: 51%

Spinal Instrumentation in Patients with Primary Spinal Infections Does Not Lead to Greater Recurrent Infection Rates: An Analysis of 118 Cases

et al. 2014

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Section: Key Resultscontrasting

confidence: 51%

Spinal Instrumentation in Patients with Primary Spinal Infections Does Not Lead to Greater Recurrent Infection Rates: An Analysis of 118 Cases

et al. 2014

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“…A large proportion of patients underwent instrumentation procedures, which have been associated with an increased incidence of complications as well. 5 A limitation of the current study is that complications such as deep wound infections may surface or lead to readmission beyond 30 postoperative days. This might lead to an underestimate of their true impact on health expenditures using the current methodology.…”

Section: Discussionmentioning

confidence: 99%

Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate

Yadla¹,

Ghobrial²,

Campbell³

et al. 2015

SPI

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OBJECT Complications after spine surgery have an impact on overall outcome and health care expenditures. The increased cost of complications is due in part to associated prolonged hospital stays. The authors propose that certain complications have a greater impact on length of stay (LOS) than others and that those complications should be the focus of future targeted prevention efforts. They conducted a retrospective analysis of a prospectively maintained database to identify complications with the greatest impact on LOS as well as the predictive value of these complications with respect to 90-day readmission rates. METHODS Data on 249 patients undergoing spine surgery at Thomas Jefferson University from May to December 2008 were collected by a study auditor. Any complications occurring within 30 days of surgery were recorded as was overall LOS for each patient. Stepwise regression analysis was performed to determine whether specific complications had a statistically significant effect on LOS. For correlation, all readmissions within 90 days were recorded and organized by complication for comparison with those complications affecting LOS. RESULTS The mean LOS for patients without postoperative complications was 6.9 days. Patients who developed pulmonary complications had an associated increase in LOS of 11.1 days (p < 0.005). The development of a urinary tract infection (UTI) was associated with an increase in LOS of 3.4 days (p = 0.002). A new neurological deficit was associated with an increase in LOS of 8.2 days (p = 0.004). Complications requiring return to the operating room (OR) showed a trend toward an increase in LOS of 4.7 days (p = 0.09), as did deep wound infections (3.3 days, p = 0.08). The most common reason for readmission was for wound drainage (n = 21; surgical drainage was required in 10 [4.01%] of these 21 cases). The most common diagnoses for readmission, in decreasing order of incidence, were categorized as hardware malpositioning (n = 4), fever (n = 4), pulmonary (n = 2), UTI (n = 2), and neurological deficit (n = 1). Complications affecting LOS were not found to be predictive of readmission (p = 0.029). CONCLUSIONS Postoperative complications in patients who have undergone spine surgery are not uncommon and are associated with prolonged hospital stays. In the current cohort, the occurrence of pulmonary complications, UTI, and new neurological deficit had the greatest effect on overall LOS. Further study is required to determine the causative factors affecting readmission. These specific complications may be high-yield targets for cost reduction and/or prevention efforts.

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“…The usual limitations to analysis apply, such as the low complication rate due to recall bias. 3 Still, in just 4 years, intrawound vancomycin use has been reported with an extremely low rate of adverse events in 6701 patients. This is even more impressive considering that all of these postoperative seromas were treated with wound revisions without any further events, and all manifestations of systemic toxicity such as nephropathy and ototoxicity were rare and transient.…”

Section: Discussionmentioning

confidence: 99%

Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review

Ghobrial

Cadotte

Williams

et al. 2015

FOC

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OBJECT The use of intrawound vancomycin is rapidly being adopted for the prevention of surgical site infection (SSI) in spinal surgery. At operative closure, the placement of vancomycin powder in the wound bed—in addition to standard infection prophylaxis—can provide high concentrations of antibiotics with minimal systemic absorption. However, despite its popularity, to date the majority of studies on intrawound vancomycin are retrospective, and there are no prior reports highlighting the risks of routine treatment. METHODS A MEDLINE search for pertinent literature was conducted for studies published between 1966 and May 2015 using the following MeSH search terms: “intrawound vancomycin,” “operative lumbar spine complications,” and “nonoperative lumbar spine complications.” This was supplemented with references and known literature on the topic. RESULTS An advanced MEDLINE search conducted on May 6, 2015, using the search string “intrawound vancomycin” found 22 results. After a review of all abstracts for relevance to intrawound vancomycin use in spinal surgery, 10 studies were reviewed in detail. Three meta-analyses were evaluated from the initial search, and 2 clinical studies were identified. After an analysis of all of the identified manuscripts, 3 additional studies were included for a total of 16 studies. Fourteen retrospective studies and 2 prospective studies were identified, resulting in a total of 9721 patients. A total of 6701 (68.9%) patients underwent treatment with intrawound vancomycin. The mean SSI rate among the control and vancomycin-treated patients was 7.47% and 1.36%, respectively. There were a total of 23 adverse events: nephropathy (1 patient), ototoxicity resulting in transient hearing loss (2 patients), systemic absorption resulting in supratherapeutic vancomycin exposure (1 patient), and culture-negative seroma formation (19 patients). The overall adverse event rate for the total number of treated patients was 0.3%. CONCLUSIONS Intrawound vancomycin use appears to be safe and effective for reducing postoperative SSIs with a low rate of morbidity. Study disparities and limitations in size, patient populations, designs, and outcomes measures contribute significant bias that could not be fully rectified by this systematic review. Moreover, care should be exercised in the use of intrawound vancomycin due to the lack of well-designed, prospective studies that evaluate the efficacy of vancomycin and include the appropriate systems to capture drug-related complications.

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Complications related to instrumentation in spine surgery: a prospective analysis

Cited by 59 publications

References 31 publications

Spinal Instrumentation in Patients with Primary Spinal Infections Does Not Lead to Greater Recurrent Infection Rates: An Analysis of 118 Cases

Spinal Instrumentation in Patients with Primary Spinal Infections Does Not Lead to Greater Recurrent Infection Rates: An Analysis of 118 Cases

Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate

Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review

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