Factors Associated with Deep Surgical Site Infection Following Spinal Surgery: A Pilot Study

Abstract

Introduction Surgical site infection (SSI) is the most common healthcare-related infection in surgical patients. Patients who have undergone spinal surgeries and have contracted postoperative SSI face increased morbidity and mortality, which invariably leads to additional burden on the healthcare system and higher costs. The risk factors for the increase in SSI in patients who have undergone spinal surgery have been investigated in numerous studies but no studies have been performed in Malaysia. The aim of this pilot study is to determine the incidence and factors associated with deep SSIs in patients that have undergone spinal surgeries. Methods This retrospective study includes all patients who underwent spinal surgeries at Tengku Ampuan Afzan Hospital, Kuantan, from 1 January 2016 to 31 December 2017. Patients with an active spinal infection, polytrauma, and open fractures were excluded from this study. Patient characteristics and laboratory investigations were extracted to determine the risk factors for deep SSI events. Associations between SSI and risk factors were analyzed with SPSS V21.0 (IBM, Armonk, NY). Results The univariate analysis indicated that fracture dislocation at the thoraco-lumbar junction (p=0.008) and a history of preoperative blood product transfusion (p=0.003) were associated with deep SSI. Other factors such as age (p=0.162), gender (p=0.262), body mass index (p=0.215), smoking status (0.272), number of vertebrae involved in the surgery (p=0.837), spinal cord involvement (p=0.259), postoperative hemoglobin reduction (p=0.816), and preoperative white blood cell count (p=0.278) were not associated with deep SSI. Conclusions This pilot study highlights the factors associated with deep SSI in spinal surgeries. A larger study is needed to further confirm these findings.

Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis

“…Heterogeneity was high ( I 2 = 58.9%), and a significant publication bias was found (Harbord’s p = 0.001). Subgroup meta-analysis of two studies analysing infection risk after elective spinal surgery 48 , 49 revealed a significant association between smoking and risk for postoperative infection (RR: 4.38; 95% CI: 2.17–8.85; p < 0.001; Fig. 3 ).…”

“…Three studies were prospective non-randomized cohort studies (14.3%; level III), 49 , 65 , 66 and 18 were retrospective studies (85.7%; level IV). 21 , 48 , 50 – 64 , 67 The overall RR for smokers to develop postoperative infections was 2.20 (95% CI: 1.69–2.86; p < 0.001; Fig. 3 ).…”

“…Altogether, 21 studies analysed risk for postoperative infection after fracture surgery ( n = 19), or elective orthopaedic surgery ( n = 2), 48 , 49 involving 13176 patients of whom 3030 were smokers (23.0%; Table 1 ). 21 , 48 – 67 Mean NOS score was 6.6 ± 1.2 points.…”

“…Altogether, 21 studies analysed risk for postoperative infection after fracture surgery ( n = 19), or elective orthopaedic surgery ( n = 2), 48 , 49 involving 13176 patients of whom 3030 were smokers (23.0%; Table 1 ). 21 , 48 – 67 Mean NOS score was 6.6 ± 1.2 points. Three studies were prospective non-randomized cohort studies (14.3%; level III), 49 , 65 , 66 and 18 were retrospective studies (85.7%; level IV).…”

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

“…This was contradictory to studies that demonstrated these associations for other surgical procedures. [39][40][41] This is possibly caused by a lack of correction for other contributing factors in smokers, such as comorbidities or ASA score. Unlike those studies, most articles included in this meta-analysis for surgical site infection 17,33 and fistula formation 7,35 performed a multivariate analysis, correcting for contributing factors.…”