Effects of Perioperative Blood Product Use on Surgical Site Infection Following Thoracic and Lumbar Spinal Surgery

Schwarzkopf, Ran; Chung, Christine; Park, Justin J.; Walsh, Michael J.; Spivak, Jeffrey M.; Steiger, David

doi:10.1097/brs.0b013e3181b86eda

Cited by 83 publications

(54 citation statements)

References 50 publications

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“…Five additional potentially relevant studies were identified from reference lists. Of the 34 articles that underwent full-text review, 12 [22][23][24][25][26][27][28][29][30][31][32][33] met eligibility criteria for inclusion in the meta-analysis and 22 were excluded. The most common reasons for exclusion of the 22 studies were: criteria for the diagnosis of SSI not reported and/or CDC/NNIS criteria not applied [34][35][36][37][38][39][40][41][42][43][44][45][46][47], non-scalar definitions of obesity used [47][48][49], risk estimates of the association between obesity/BMI and SSI not reported or raw data not provided to calculate risks [44,47,[50][51][52][53], and analyses restricted to deep wound infections [54,55].…”

Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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Purpose Inconsistent results have been reported in the literature on the association between obesity, expressed as increased body mass index (BMI), and risk for surgical site infection (SSI) following spine surgery. The objective of this study was to review and quantify the association between increased BMI and risk of spinal SSI in adults. Methods We performed a comprehensive search for relevant studies using PubMed, Embase, and references of published manuscripts. Study-specific risk measures were transformed into slope estimates and combined using the random effects meta-analysis model to establish the risk of SSI associated with every 5-unit increase in BMI. Results Thirty-four articles underwent full-text review. Variations were noted among these studies in relation to SSI diagnosis criteria and BMI cut-off levels used to define obesity. Data from 12 retrospective studies were included in the analyses. Results showed that BMI was significantly positively associated with the risk of spinal SSI. Unadjusted risk estimates demonstrated that a 5-unit increase in BMI was associated with 13 % increased risk of SSI [Crude odds ratio (OR): 1.13; 95 % CI: 1.07-1.19, p\ 0.0001]. Pooling of risk estimates adjusted for diabetes and other confounders resulted in a 21 % increase in risk of spinal SSI for every 5-unit increase in BMI (adjusted OR: 1.21; 95 % CI 1.13-1.29, p \ 0.0001). ConclusionHigher BMI is associated with the increased risk of SSI following spine surgery. Prospective studies are needed to confirm this association and to determine whether other measures of fat distribution are better predictors of risk of SSI.

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Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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“…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%

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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“…42 Previous studies have also used case-control analyses rather than multivariate analyses to identify factors associated with postoperative spinal infection. 11,12,22,29,32,39 This does not control for interrelated factors. Maragakis and colleagues compared 104 patients who developed spinal infections to 104 patients randomly selected who underwent any type of spine surgery.…”

Section: Previous Postoperative Spinal Infection Studiesmentioning

confidence: 99%

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

Chaichana

Bydon

Santiago-Dieppa

et al. 2014

SPI

118

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Object. Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure. The authors' goals were therefore to ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections.Methods. Data obtained in adult patients who underwent instrumented posterior lumbar fusion for degenerative spine disease between 1993 and 2010 were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection. Variables with p < 0.05 were considered statistically significant.Results. During the study period, 817 consecutive patients underwent lumbar fusion for degenerative spine disease, and 37 patients (4.5%) developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9). The factors independently associated with an increased risk of infection were increasing age (RR 1.004 [95% CI 1.001- Conclusions. This study identifies that several factors-older age, diabetes, obesity, prior spine surgery, and length of hospital stay-were each independently associated with an increased risk of developing infection among patients undergoing instrumented lumbar fusion for degenerative spine disease. The overwhelming majority of these patients were treated effectively without hardware removal.

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Effects of Perioperative Blood Product Use on Surgical Site Infection Following Thoracic and Lumbar Spinal Surgery

Cited by 83 publications

References 50 publications

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

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

Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

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