Development and validation of a point-of-care clinical risk score to predict surgical site infection following open spinal fusion

Mueller, Kyle; Hou, Yuefeng; Beach, Karen; Griffin, Leah

doi:10.1016/j.xnsj.2022.100196

Cited by 6 publications

(6 citation statements)

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“…In the present study, we examined the SSC-AR rate in a fusion-dominant population (87.5%), and its relationship with patient, facility, and procedure risk factors. By utilizing a more comprehensive definition of SSCs, we have expanded upon our previous SSI prediction model ( 39 ) to include a range of wound complications that occur following open spine surgeries. The complication rate (2.0%) identified through our database query is consistent with findings from other published studies.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a point-of-care clinical risk score to predict surgical site complication-associated readmissions following open spine surgery

Mueller,

Hou,

Beach

et al. 2024

J Spine Surg

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Background Surgical site complications (SSCs) contribute to increased healthcare costs. Predictive analytics can aid in identifying high-risk patients and implementing optimization strategies. This study aimed to develop and validate a risk-assessment score for SSC-associated readmissions (SSC-ARs) in patients undergoing open spine surgery. Methods The Premier Healthcare Database (PHD) of adult patients (n=157,664; 3,182 SSC-ARs) between January 2019 and September 2020 was used for retrospective data analysis to create an SSC risk score using mixed effects logistic regression modeling. Full and reduced models were developed using patient-, facility-, or procedure-related predictors. The full model used 37 predictors and the reduced used 19. Results The reduced model exhibited fair discriminatory capability (C-statistic =74.12%) and demonstrated better model fit [Pearson chi-square/degrees of freedom (DF) =0.93] compared to the full model (C-statistic =74.56%; Pearson chi-square/DF =0.92). The risk scoring system, based on the reduced model, comprised the following factors: female (1 point), blood disorder [2], congestive heart failure [2], dementia [3], chronic pulmonary disease [2], rheumatic disease [3], hypertension [2], obesity [2], severe comorbidity [2], nicotine dependence [1], liver disease [2], paraplegia and hemiplegia [3], peripheral vascular disease [2], renal disease [2], cancer [1], diabetes [2], revision surgery [2], operative hours ≥5 [4], emergency/urgent surgery [2]. A final risk score (sum of the points for each surgery; range, 0–40) was validated using a 1,000-surgery random hold-out sample (C-statistic =85.16%). Conclusions The resulting SSC-AR risk score, composed of readily obtainable clinical information, could serve as a robust predictive tool for unplanned readmissions related to wound complications in the preoperative setting of open spine surgery.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a point-of-care clinical risk score to predict surgical site complication-associated readmissions following open spine surgery

Mueller,

Hou,

Beach

et al. 2024

J Spine Surg

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“…и более) необходима не только санация гнойного очага, но и трехколонная реконструкция позвоночника с коррекцией параметров сагиттального баланса как ключевого критерия обеспечения качества жизни пациента в послеоперационном периоде [5]. Проведение подобных операций сопряжено с высокими рисками развития глубокой инфекции области хирургического вмешательства (ИОХВ) как в раннем (первые 30 сут после вмешательства), так и в отдаленном периоде [6][7][8][9]. Прогрессирование инфекционного процесса чаще приводит к формированию двух патологических состояний: потере сегментарной стабильнос-ти с развитием псевдоартроза и вторичному стенозу позвоночного канала с неврологическими нарушениями [10][11][12].…”

Section: Objectiveunclassified

Microbiological spectrum of SSI pathogens in patients with chronic infectious spondylitis requiring revision surgery: results of continuous monocentric 5-year monitoring

Naumov,

Vishnevskiy,

Solovieva

et al. 2023

Hir. pozvonoč.

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Objective. To analyze the results of the continuous monocentric 5-year microbiological monitoring of causative agents of surgical site infection (SSI) in patients who underwent primary surgery for chronic infectious spondylitis and required revision surgery.Material and Methods. The study included patient data from 2018 to 2022. The primary cohort included 569 consecutively operated patients with chronic infectious spondylitis of nonspecific (n1 = 214) and tuberculous (n2 = 355) etiology. The analyzed sample was formed taking into according to inclusion and exclusion criteria. Thus, in 99 patients who required revision surgical interventions due to the development of SSI, a continuous microbiological monitoring of pathogens was performed, including the assessment of drug resistance and the timing of the development of infectious complications. Periodization of the time of SSI development was performed according to the accepted classification of Prinz et al. (2020), the assessment of drug resistance spectrum was performed according to the EUCAST recommendations (2020) and taking into account the approved methodological recommendations.Results. In the general structure of surgical interventions for chronic infectious spondylitis, the share of revision interventions due to the development of SSI was 17.4 %. The highest incidence of complications was noted in the late postoperative period (χ2 = 9.237; p = 0.009). Bacterial detection from the material of vertebral localization was noted in 43 cases (48.3 %), pathogen strains were isolated in urine in 28 (60.8 %), in decubital ulcers in 11 (23.9 %) and in hemoculture in 7 (15.2 %) patients. Culture negative SSI was detected in 10 cases (10.1 %) in the late period. Infectious complications in the setting of chronic non-specific spondylitis were detected more frequently than in spondylitis of tuberculous etiology (χ2 = 21.345; p < 0.001). Gram-positive multidrug-resistant and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, and Gram-positive strains without drug resistance in that of early and delayed SSI (χ2 = 17.516; p = 0.0032).Conclusion. Drug-resistant Gram-positive bacteria predominate in the structure of SSI with a significantly higher frequency of complication development. Nonspecific etiology of spondylitis is associated with a significantly higher incidence of SSI. In the absence of a positive result of bacteriological examination of the material of vertebral localization, it is advisable to collect blood, decubital ulcer secretion and urine sampling.

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“…The progression of the infectious process often leads to the formation of two pathological conditions: loss of segmental stability with the development of pseudo-arthrosis and secondary vertebral canal stenosis with neurological disorders [ 22 , 23 , 24 , 25 ]. The main tasks to be solved during revision surgery include halting the signs of local and systemic inflammation, restoring vertebral stability, and decompressing intra-canal neural structures [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Spectrum of Surgical Site Infection Pathogens in Chronic Infectious Spondylitis Requiring Revision Surgery: A 5-Year Cohort Study

Naumov,

Vishnevsky,

Linkova

et al. 2024

JCM

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Background: Spectrum monitoring of the pathogen in spondylitis patients plays a key role in preventing infectious complications of spinal reconstructions in chronic spondylitis (CS) and in the treatment of surgical site infection (SSI). The aim of this study is to characterize the spectrum of SSI pathogens in CS requiring revision surgery. Methods: The primary cohort encompassed 569 surgical patients with infectious CS. In 99 patients (61 men and 38 women) requiring revision surgical interventions due to SSI, continuous microbiological monitoring of the pathogens was conducted. The average age of the patients was 63 ± 14 years. The vast majority of the patients underwent surgery on a set of multilevel (two or more spinal–motor segments) lesions. Lesions of the lumbar spine were more often noted, and lesions of the thoracic, thoracolumbar, and cervical spine sections were less often noted. This study included all patients operated on within the scope of revision spinal reconstructions in connection with the development of infection of the surgical area over the period from January 2018 to December 2022. Inclusion criteria were etiologically verified spondylitis, age of 18 years or older, and follow-up of 6 months or more. Results: The average rate of revision surgery due to SSI was 17.4%. Germ detection from the material of vertebral localization was noted in 48.3% and pathogen strains were isolated in urine in 60.8%, in decubital ulcers in 23.9%, and in hemoculture in 15.2% of all study patients. Aseptic, deep SSI was detected in 10.1%. Gram-positive, multidrug-resistant, and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, early, and delayed Gram-positive strains without drug resistance. Conclusions: Infectious etiology of spondylitis is associated with a significantly higher frequency of SSI. In the absence of a positive result from bacteriological examination of the vertebral localization material, it is advisable to conduct blood, decubital ulcer discharge, and urine sampling.

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Development and validation of a point-of-care clinical risk score to predict surgical site infection following open spinal fusion

Cited by 6 publications

References 50 publications

Development and validation of a point-of-care clinical risk score to predict surgical site complication-associated readmissions following open spine surgery

Development and validation of a point-of-care clinical risk score to predict surgical site complication-associated readmissions following open spine surgery

Microbiological spectrum of SSI pathogens in patients with chronic infectious spondylitis requiring revision surgery: results of continuous monocentric 5-year monitoring

Spectrum of Surgical Site Infection Pathogens in Chronic Infectious Spondylitis Requiring Revision Surgery: A 5-Year Cohort Study

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