Risk and Protective Factors Associated with Surgical Infections among Spine Patients

Blood, Alyssa; Sandoval, Melanie F.; Burger, Evalina L.; Halverson-Carpenter, Katherine

doi:10.1089/sur.2016.183

Cited by 41 publications

(37 citation statements)

References 31 publications

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“…37 It should be noted that antibiotic dosage (cefazolin <20 mg/kg) needs to be adjusted appropriately in obese patients to be effective in reducing infection risk. 38,39 It should also be noted that antibiotics should be redosed every 4 hours or after 1500 mL of blood loss in spinal deformity cases. 40 Furthermore, special consideration must be made to recognize patients that are at risk for harboring gram-negative species, such as incontinent patients or those that have a history of urinary tract colonization.…”

Section: Preoperative Antibioticsmentioning

confidence: 99%

Surgical Site Infection Prevention Following Spine Surgery

Aleem

Tan

Nassr

et al. 2020

Global Spine Journal

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Study Design: Literature review. Objectives: Surgical site infection (SSI) following spine surgery leads to significant patient morbidity, mortality, and increased health care costs. The purpose of this article is to identify risk factors and strategies to prevent SSIs following spine surgery, with particular focus on avoiding infections in posterior cervical surgery. Methods: We performed a literature review and synthesis to identify methods that can be used to prevent the development of SSI following spine surgery. Specific pearls for preventing infection in posterior cervical spine surgery are also presented. Results: SSI prevention can be divided into patient and surgeon factors. Preoperative patient factors include smoking cessation, tight glycemic control, weight loss, and nutrition optimization. Surgeon factors include screening and treatment for pathologic microorganisms, skin preparation using chlorhexidine and alcohol, antimicrobial prophylaxis, hand hygiene, meticulous surgical technique, frequent irrigation, intrawound vancomycin powder, meticulous multilayered closure, and use of closed suction drains. Conclusion: Prevention of SSI following spine surgery is multifactorial and begins with careful patient selection, preoperative optimization, and meticulous attention to numerous surgical factors. With careful attention to various patient and surgeon factors, it is possible to significantly reduce SSI rates following spine surgery.

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Section: Preoperative Antibioticsmentioning

confidence: 99%

Surgical Site Infection Prevention Following Spine Surgery

Aleem

Tan

Nassr

et al. 2020

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…20 Increased tissue necrosis from retraction injury may also contribute. 4,5 However, some studies have failed to find a relationship between obesity and SSI. 21,22 These variable findings may be related to comorbid conditions that manifest with obesity, such as diabetes, as well as differences in surgical technique.…”

Section: Patient Factorsmentioning

confidence: 99%

“…40 In addition, the antibiotic dosage (cefazolin <20 mg/kg), should be adjusted with regard to obese patients in order to further reduce the risk of infection. 4,18 It is also important to note the need to redose the antibiotics every 4 hours and, in spinal deformities, after 1500 mL of blood loss due to the washout effect. 41,42 Skin Cleansing.…”

Section: Patient Factorsmentioning

confidence: 99%

Risk Factors and Prevention of Surgical Site Infections Following Spinal Procedures

Nasser

Kosty

Shah

et al. 2018

Global Spine Journal

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Study Design:Focused literature review.Objective:The objective of this article was to help identify potential risk factors as well as strategies to help prevent surgical site infections (SSIs) in spine surgery.Methods:An article search was performed using PubMed, EMBASE, and the Cochrane database of systematic reviews using the terms “surgery” OR “surgical” AND “spine” OR “spinal” AND “infection”. Systematic review articles, meta-analyses, and clinical trials with more than 100 patients were reviewed.Results:Both patient and perioperative factors contribute to the development of SSIs. Patient factors such as smoking, obesity, diabetes, Methicillin-resistant Staphylococcus aureus (MRSA) colonization, and malnutrition are all modifiable risk factors that can lead to SSIs. Procedural steps, including preoperative MRSA screening and treatment for colonization, preoperative antibiotics, skin preparation, minimizing operative time, antibiotic or betadine irrigation, avoiding personnel turnover, and postoperative wound care have also been shown to decrease infection rates.Conclusion:There are several measures a spine practitioner may be able to take in the preoperative, intraoperative, and postoperative settings. Protocols to counsel patients regarding modification of preexisting risk factors and ensure adequate antimicrobial therapy in the perioperative period may be developed to reduce SSIs in spine surgery.

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“…Despite our careful randomisation of the study arms, we found that the antibiotics group had a considerably higher proportion of females than the control group (80.6% vs 63.6%), although the difference did not reach statistical significance. Some previous studies of SWI at other anatomic sites reported a higher risk in female patients, whereas others showed a higher risk in male patients . In the head and neck literature, Man et al found no sex difference in the rate of SWI following neck dissection, and Shkedy et al found that women had a higher incidence of SWI after parotidectomies than men.…”

Section: Discussionmentioning

confidence: 97%