Postoperative Spinal Wound Infections and Postprocedural Diskitis

Chaudhary, Saad B.; Vives, Michael J.; Basra, Sushil; Reiter, Mitchell F.

doi:10.1080/10790268.2007.11753476

Cited by 117 publications

(150 citation statements)

References 74 publications

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“…4,6,8,30,34 Postoperative spinal infections present a challenge to surgeons, as they require urgent diagnosis and management to prevent deleterious sequelae, such as acute neurological decompensation, osteomyelitis, pseudarthrosis, and epidural abscess. 12,19 Accordingly, their management must be aggressive, often requiring surgical debridement, additional imaging and laboratory tests, and culture-directed parenteral antibiotic therapy.…”

mentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

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OBJECT Infections following spine surgery negatively affect patient quality of life (QOL) and impose a significant financial burden on the health care system. Postoperative wound infections occur at higher rates following dorsal cervical procedures than ventral procedures. Quantifying the health outcomes and costs associated with infections following dorsal cervical procedures may help to guide treatment strategies to minimize the deleterious consequences of these infections. Therefore, the goals of this study were to determine the cost and QOL outcomes affecting patients who developed deep wound infections following subaxial dorsal cervical spine fusions. METHODS The authors identified 22 (4.0%) of 551 patients undergoing dorsal cervical fusions who developed deep wound infections requiring surgical debridement. These patients were individually matched with control patients who did not develop infections. Health outcomes were assessed using the EQ-5D, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and visual analog scale (VAS). QOL outcome measures were collected preoperatively and after 6 and 12 months. Health resource utilization was recorded from patient electronic medical records over an average follow-up of 18 months. Direct costs were estimated using Medicare national payment amounts, and indirect costs were based on patients' missed workdays and income. RESULTS No significant differences in preoperative QOL scores were found between the 2 cohorts. At 6 months postsurgery, the noninfection cohort had significant pre- to postoperative improvement in EQ-5D (p = 0.02), whereas the infection cohort did not (p = 0.2). The noninfection cohort also had a significantly higher 6-month postoperative EQ-5D scores than the infection cohort (p = 0.04). At 1 year postsurgery, there was no significant difference in EQ-5D scores between the groups. Health care–associated costs for the infection cohort were significantly higher ($16,970 vs $7658; p < 0.0001). Indirect costs for the infection cohort and the noninfection cohort were $6495 and $2756, respectively (p = 0.03). Adjusted for inflation, the total costs for the infection cohort were $21,778 compared with $9159 for the noninfection cohort, reflecting an average cost of $12,619 associated with developing a postoperative deep wound infection (p < 0.0001). CONCLUSIONS Dorsal cervical infections temporarily decrease patient QOL postoperatively, but with no long-term impact; they do, however, dramatically increase the cost of care. Knowledge of the financial burden of wound infections following dorsal cervical fusion may stimulate the development and use of improved prophylactic and therapeutic techniques to manage this serious complication.

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mentioning

confidence: 99%

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Kuhns

Lubelski

Alvin

et al. 2015

SPI

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“…Consideration should also be given to identifying potential infections by nasal swabs and the use of antibiotic nasal ointment, wound lavage with normal saline or with normal saline and antibiotic [39]. More chronic infections have been shown to be associated with propionibacterium acnes [40,43].…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…Methods quoted for prevention are antibiotic prophylaxis, surgical technique to avoid necrotic tissue, avoiding 'at risk patients', reduction of haematomas, optimising surgical conditions and treating co-existing infections. Post-operatively care needs to be taken as infection can also occur due to soiling of the incision in the fresh postoperative phase [43]. More than ever the treatment of spinal infections requires a multidisciplinary team to include microbiologists, neuroradiologists and spinal surgeons with the key being early detection [5,22].…”

Section: Introductionmentioning

confidence: 99%

Infections associated with spinal implants

Quaile

2012

International Orthopaedics (SICOT)

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Spinal infections represent a difficult challenge to treating clinicians. Infections in the presence of implants are even more so. In this review the literature appears to reflect a change of practice in which the aim is to retain implants if possible. The newer spinal procedures such as disc replacements pose different problems largely due to the more difficult access. The situation in the spine is more difficult than in general orthopaedics when dealing with infection due to the requirement for stability and to protect neurological function. The main thrust of management, therefore, is early diagnosis and a high index of suspicion followed by adequate if not radical management in a multidisciplinary setting. In the event prevention is better than cure and therefore consideration of the various mechanisms to avoid infection must be taken. There are some 'novel' considerations for the avoidance of infection alongside the tried and tested techniques. There are also new procedures for wound closure and the elimination of dead space.

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“…Literature focusing on antibiotic regimens in spinal SSI is even sparser (3,5). Most publications or experts recommend a minimum length of intravenous antibiotic courses of 4-6 weeks, often followed by prolonged oral antimicrobial regimens (3,(6)(7)(8)(9), or they do not pronounce on detailed antibiotic modalities at all (10)(11)(12). Most of these recommendations are reviews and lack own data (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Variables associated with remission in spinal surgical site infections

Billières¹,

Uçkay²,

Faúndez³

et al. 2016

J. Spine Surg.

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Background: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.Methods: Single-centre case-control study [2007][2008][2009][2010][2011][2012][2013][2014]. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.Results: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements.The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Conclusions:In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

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Postoperative Spinal Wound Infections and Postprocedural Diskitis

Cited by 117 publications

References 74 publications

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

Infections associated with spinal implants

Variables associated with remission in spinal surgical site infections

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