Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures

Gu, Wenfei; Tu, Lei; Liang, Zhaoming; Wang, Zhenbin; Aikenmu, Kahaer; Chu, Gao; Zhang, Enfeng; Zhao, Juan

doi:10.1016/j.ajic.2017.09.025

Cited by 32 publications

(26 citation statements)

References 21 publications

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“…Decompression and spinal fusion are considered to be the gold standard for lumbar degenerative disease; however, the benefit of spinal fusion is associated with higher complications, such as significant instrumentation failure, infection, and accelerated degeneration of adjacent segments. [ 1 2 3 ] Dynamic stabilization is a potential alternative to rigid lumbar fusion for lumbar degenerative disease. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis

Zhang

et al. 2018

Chinese Medical Journal

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Background:Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization.Methods:Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD).Results:There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively.Conclusions:Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.

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Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis

Zhang

et al. 2018

Chinese Medical Journal

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“…The incidence of SSI decreased from 19.4% in the pre-intervention group to 2.6% in the post-intervention group, which is comparable to the overall infection rate in some previous studies that included instrumentation. 2,3 The infections that occurred in the pre-intervention period were mainly caused by microorganisms that are part of the enteric flora such as Gram-negative bacilli. This fact suggested perioperative contamination of the wound as the source of these pathogens, considering that most of the interventions were located in the lumbar area.…”

Section: Discussionmentioning

confidence: 99%

“…Obesity is one of the most prevalent health problems in the developed world. 15 Many studies 2,5,[15][16][17][18][19][20] have shown that being overweight increases the risk of SSI in spinal surgery, possibly due to its association with other comorbidities, the increase in operative time, greater bleeding, a higher probability of underdosing of antibiotic prophylaxis, and delayed mobilization in the postoperative period. Consequently, weight loss should be included in the list of optimization measures prior to spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Reports in the literature indicate that the incidence of spinal SSI varies between 0.5% and 18.8%, with the main risk factors for infection depending on the patient (obesity, diabetes, smoking, corticosteroid therapy, previous hospital stay), the surgical procedure (instrumentation, implants, number of levels operated, site of surgery, duration of the intervention, dural tear, revision surgery, need for transfusion), and the postoperative period (days of drainage, incontinence, prolonged bed rest). [1][2][3][4][5][6][7][8][9][10][11][12] SSIs after spine surgery usually occur due to direct inoculation during the surgical procedure and less frequently by hematogenous spread or early postoperative contamination. Staphylococcus aureus is the most frequent etiology, causing 12%-65% of infections, followed by coagulase-negative staphylococci, especially in the presence of prosthetic implants.…”

Section: Introductionmentioning

confidence: 99%

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Intervention to reduce the incidence of surgical site infection in spine surgery

Castellà

Sopena

Rodriguez-Montserrat

et al. 2020

American Journal of Infection Control

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Background: This study examines the incidence, characteristics, and risk factors of surgical site infections (SSIs) after spine surgery and evaluates the efficacy of a preventive intervention. Methods: This was a quasi-experimental pretest/posttest study in patients undergoing spinal surgery in an orthopedic surgery department from December 2014 to November 2016. Based on the results of the study, we revised the preventive protocol with modification of wound dressing, staff training, and feedback. SSI rates were compared between the pre-intervention (December 2014 to November 2015) and post-intervention (December 2015 to November 2016) periods. The risk factors were analyzed using univariate and multivariate analyses. Results: Of the 139 patients included, 14 cases of SSI were diagnosed, with a significant decrease in the incidence of SSIs from the pre-intervention period to the post-intervention period (19.4% vs 2.6%; P = .001). The etiology was known in 13 cases, with enteric flora being predominant in the pre-intervention group. Univariate analysis showed that age, body mass index, days until sitting and ambulation, and incontinence were statistically significant risk factors. After multivariate analysis, only body mass index and days until ambulation remained significant. When the effect of intervention was adjusted with other risk factors, this variable remained statistically significant. Conclusions: An intervention that includes modification of wound dressing and early mobilization, as well as staff awareness training, monitoring, and feedback, allowed a significant reduction in the incidence of SSI following spinal surgery, particularly infections caused by enteric flora.

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“…We read with great interest the article by Ferreira et al 1 The authors tried to determine the effects of patient risk factors (RFs) on admission and acquired during inpatient stay on the risk of health care-associated infection using a matched case-control design. 1 After reading this article carefully and critically, we think that the resulting effect estimates for some patient RFs may be along with degree of bias.…”

Section: Dear Editormentioning

confidence: 99%

Comments on incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1,764 instrumented spine procedures

Safiri

Ayubi

2018

American Journal of Infection Control

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We were interested in the recent article by Gu et al. 1 The authors provide interesting results; however, some methodologic and statistical issues should be noted. First, the authors point out that in univariate models, reason for surgery was the only significant risk factor of surgical site infection (SSI) after surgery (P < .05) and they did not attempt to estimate the effect size in univariate models. 1 It is crucial to emphasize that judgment about the strength of a risk factor based on only P value can be misleading because the value of a P value is a function of sample size, standard deviation, and effect size. As a general rule in biomedical research, the effect sizes will be estimated in univariate analysis and multivariable models 2,3 ; moreover, in univariate analysis a liberal P value such as < .10 or < .20 will be considered a criterion for statistical significance. 3 Second, the authors entered all the studied risk factors into the multivariable model. 1 However, the principle of parsimony states in statistical modeling, simpler models are preferred over more complex models because simpler models can provide better predictive abilities. 3 To derive simpler models, investigators and clinicians use stepwise methods and prior knowledge for selecting variables in the multivariable analysis. 3 Third, the design of the study was cross-sectional; however, in such designs the possibility of true association and causality is not possible because temporality (ie, exposure before outcome) may not be met. 4

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Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures

Cited by 32 publications

References 21 publications

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis

Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis

Intervention to reduce the incidence of surgical site infection in spine surgery

Comments on incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1,764 instrumented spine procedures

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