Incidence and risk of delayed surgical site infection following instrumented lumbar spine fusion

Lewkonia, Peter; DiPaola, Christian P.; Street, John

doi:10.1016/j.jocn.2015.05.039

Cited by 29 publications

(16 citation statements)

References 26 publications

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“…Therefore, this analysis and scoring system is limited to 30 days for wound complication prediction, even though other studies have reported wound complications after 30 days as supported by Figure 2 . [ 27 ] In addition, NSQIP is not a spine database and therefore does not report spine-specific variables. Unreported variables not included in this analysis that would be important in relation to wound complications include antibiotics administered, drains used, and other closure methods.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for wound complications following spine surgery

Piper¹,

Tomlinson²,

Santangelo³

et al. 2017

Surg Neurol Int

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Background:Wound complications, including surgical site infections (SSIs) and wound dehiscence, are among the most common complications following spine surgery often leading to readmission. The authors sought to identify preoperative characteristics predictive of wound complications after spine surgery.Methods:The American College of Surgeons National Surgical Quality Improvement Program database for years 2012–2014 was reviewed for patients undergoing spine surgery, defined by the Current Procedural Terminology codes. Forty-four preoperative and surgical characteristics were analyzed for associations with wound complications.Results:Of the 99,152 patients included in this study, 2.2% experienced at least one wound complication (superficial SSI: 0.9%, deep SSI: 0.8%, organ space SSI: 0.4%, and dehiscence: 0.3%). Multivariate binary logistic regression testing found 10 preoperative characteristics associated with wound complications: body mass index ≥30, smoker, female, chronic steroid use, hematocrit <38%, infected wound, inpatient status, emergency case, and operation time >3 hours. A risk score for each patient was created from the number of characteristics present. Receiver operating characteristic curves of the unweighted and weighted risk scores generated areas under the curve of 0.701 (95% CI: 0.690–0.713) and 0.715 (95% CI: 0.704–0.726), respectively. Patients with unweighted risk scores >7 were 25-fold more likely to develop a wound complication compared to patients with scores of 0. In addition, mortality rate, reoperation rate, and total length of stay each increased nearly 10-fold with increasing risk score.Conclusion:This study introduces a novel risk score for the development of wound dehiscence and SSIs in patients undergoing spine surgery, using new risk factors identified here.

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Section: Discussionmentioning

confidence: 99%

Risk factors for wound complications following spine surgery

Piper¹,

Tomlinson²,

Santangelo³

et al. 2017

Surg Neurol Int

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“…Nevertheless, most infections occur early in the postoperative period, typically within the first 3 months. Infections occurring more than 3 months after surgery are rare 14 ) : the incidence of delayed surgical site infection following posterior instrumented spinal surgery is about 0.2%, and the diagnosis can be challenging 13 ) . It has been reported that these delayed infections are associated with hematogenous seeding such as those occurring with intravenous drug use, urinary tract infection, neurogenic bladder, and pyelonephritis 15 , 16 ) .…”

Section: Discussionmentioning

confidence: 99%

“…The use of prophylactic antibiotic therapy is reported to reduce the occurrence of delayed surgical site infection 14 ) . We may have to consider removing instrumentation to avoid delayed surgical site infection in such high-risk patients after complete bony fusion has occurred.…”

Section: Discussionmentioning

confidence: 99%

Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report

et al. 2020

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Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery. Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae. Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided. Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.

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“…The postoperative wound care science appears to fall more into the realm of myth, with little-reported data regarding dressing care, time allotted for patient bathing, and postoperative drain use [ 9 ]. At the baseline comparative year in this study, antibiotics were continued while drains were in place, although there is no data to support this practice [ 6 ]. In addition, routine wound management, for both cranial and spinal patients, involved removal of the closed surgical dressing on postoperative day #2, and allowed for bathing or cleansing on postoperative day #3.…”

Section: Discussionmentioning

confidence: 99%

Surgical Adhesive Drape (IO-ban) as Postoperative Surgical Site Dressing

Felbaum¹,

Syed²,

Snyder³

et al. 2015

Cureus

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Study Design: Retrospective chart analysis.Objective: The objective of this study is to describe the senior author’s (MNN) experience applying a widely available surgical drape as a postoperative sterile surgical site dressing for both cranial and spinal procedures.Summary of Background Data: Surgical site infection (SSI) is an important complication of spine surgery that can result in significant morbidity. There is wide variation in wound care management in practice, including dressing type. Given the known bactericidal properties of the surgical drape, there may be a benefit of continuing its use immediately postoperatively.Methods: All of the senior author’s cases from September 2014 through September 2015 were reviewed. These were contrasted to the previous year prior to the institution of a sterile surgical drape as a postoperative dressing.Results: Only one surgical case out of 157 operative interventions (35 cranial, 124 spinal) required operative debridement due to infection. From September 2013 to September 2014, prior to the institution of a sterile surgical drape as dressing, the author had five infections out of 143 operations (46 cranial, 97 spinal) requiring intervention.Conclusion: The implementation of a sterile surgical drape as a closed postoperative surgical site dressing has led to a decrease in surgical site infections. The technique is simple and widely available, and should be considered for use to diminish surgical site infections.

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Incidence and risk of delayed surgical site infection following instrumented lumbar spine fusion

Cited by 29 publications

References 26 publications

Risk factors for wound complications following spine surgery

Risk factors for wound complications following spine surgery

Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report

Surgical Adhesive Drape (IO-ban) as Postoperative Surgical Site Dressing

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