Risk Factors for Postoperative Infection Following Posterior Lumbar Instrumented Arthrodesis

Koutsoumbelis, Stelios; Hughes, Alexander P.; Girardi, Federico P.; Cammisa, Frank P.; Finerty, Eileen; Nguyen, Joseph; Gausden, Elizabeth B.; Sama, Andrew A.

doi:10.2106/jbjs.j.00039

Cited by 226 publications

(184 citation statements)

References 24 publications

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“…Furthermore, moderate significant heterogeneity was observed between studies of the unadjusted risk estimate. Influence analysis showed that this heterogeneity was mostly due to the high OR reported by Koutsoumbelis et al [26]. However, after adjusting for confounders, the study's results approximated those from other studies.…”

Section: Odds Ratiomentioning

(Expert classified)

“…Five additional potentially relevant studies were identified from reference lists. Of the 34 articles that underwent full-text review, 12 [22][23][24][25][26][27][28][29][30][31][32][33] met eligibility criteria for inclusion in the meta-analysis and 22 were excluded. The most common reasons for exclusion of the 22 studies were: criteria for the diagnosis of SSI not reported and/or CDC/NNIS criteria not applied [34][35][36][37][38][39][40][41][42][43][44][45][46][47], non-scalar definitions of obesity used [47][48][49], risk estimates of the association between obesity/BMI and SSI not reported or raw data not provided to calculate risks [44,47,[50][51][52][53], and analyses restricted to deep wound infections [54,55].…”

Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

“…Influence analysis for the unadjusted estimate showed that the study by Koutsoumbelis et al [26] was responsible for almost all heterogeneity detected between the ten studies. Elimination of this study resulted in zero heterogeneity across the remaining studies (I 2 = 0.0 %, p for Q test \0.0001) but did not significantly influence the magnitude of the summary estimate.…”

Section: Sensitivity Analyses and Publication Biasmentioning

confidence: 94%

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Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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Purpose Inconsistent results have been reported in the literature on the association between obesity, expressed as increased body mass index (BMI), and risk for surgical site infection (SSI) following spine surgery. The objective of this study was to review and quantify the association between increased BMI and risk of spinal SSI in adults. Methods We performed a comprehensive search for relevant studies using PubMed, Embase, and references of published manuscripts. Study-specific risk measures were transformed into slope estimates and combined using the random effects meta-analysis model to establish the risk of SSI associated with every 5-unit increase in BMI. Results Thirty-four articles underwent full-text review. Variations were noted among these studies in relation to SSI diagnosis criteria and BMI cut-off levels used to define obesity. Data from 12 retrospective studies were included in the analyses. Results showed that BMI was significantly positively associated with the risk of spinal SSI. Unadjusted risk estimates demonstrated that a 5-unit increase in BMI was associated with 13 % increased risk of SSI [Crude odds ratio (OR): 1.13; 95 % CI: 1.07-1.19, p\ 0.0001]. Pooling of risk estimates adjusted for diabetes and other confounders resulted in a 21 % increase in risk of spinal SSI for every 5-unit increase in BMI (adjusted OR: 1.21; 95 % CI 1.13-1.29, p \ 0.0001). ConclusionHigher BMI is associated with the increased risk of SSI following spine surgery. Prospective studies are needed to confirm this association and to determine whether other measures of fat distribution are better predictors of risk of SSI.

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Section: Odds Ratiomentioning

(Expert classified)

Section: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

Section: Sensitivity Analyses and Publication Biasmentioning

confidence: 94%

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Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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“…Continuous variables analyzed includes patient's age, body mass index (BMI), length of operation, duration of hospitalization, number of intervertebral levels operated on, preoperative glucose levels, and estimated blood loss. These risk factors were chosen based on the previous literature evaluating SSI in spinal surgeries [7,10,11,16].…”

Section: Methodsmentioning

confidence: 99%

Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery?

Lau

Yeo

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates. Questions/purposes (1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI? Methods Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested casecontrol analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case's date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed.Results Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0-32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3-17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6-7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0-1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection. Conclusions In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…More specifically, patients who are obese may have difficulties with surgical access and there have been reports of an increased risk of operative complications for surgical procedures such as spinal surgery [4,6,8,17,22,23,29,35]. Some studies reported that obesity has been associated with unfavorable surgical outcomes such as longer operative times, greater operative blood loss, and a higher rate of revision for patients having spinal surgery [10,14,31,32,35,39].…”

Section: Introductionmentioning

confidence: 99%

Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis

Jiang

Teng

Fan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

170

130

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Background As obesity becomes more prevalent, it becomes more common among patients considering orthopaedic surgery, including spinal surgery. However, there is some controversy regarding whether obesity is associated with complications, failed reconstructions, or reoperations after spinal surgery. Questions/purposes We wished to determine, in patients undergoing spine surgery, whether obesity is associated with (1) surgical site infection, (2) mortality and the need for revision surgery after spinal surgery, and (3) increased surgical time and blood loss. Methods A systematic literature search was performed to collect comparative or controlled studies that evaluated the influence of obesity on the surgical and postoperative outcomes of spinal surgery. Two reviewers independently selected trials, extracted data, and assessed the methodologic quality and quality of evidence. Pooled odds ratios (OR) and mean differences (MD) with 95% CIs were calculated using the fixed-effects model or random-effects model. Data were analyzed using RevMan 5.1. MOOSE criteria were used to ensure this project's validity. Thirtytwo studies involving 97,326 patients eventually were included. Results Surgical site infection (OR, 2.33; 95% CI, 1.94-2.79), venous thromboembolism (OR, 3.15; 95% CI, 1.92-5.17), mortality (OR, 2.6; 95% CI, 1.50-4.49), revision rate (OR, 1.43; 95% CI, 1.05-1.93) operating time (OR, 14.55; 95% CI,, and blood loss (MD, 28.89; 95% CI,, were all significantly increased in the obese group. Conclusion Obesity seemed to be associated with higher risk of surgical site infection and venous thromboembolism, more blood loss, and longer surgical time. Future prospective studies are needed to confirm the relationship between obesity and the outcome of spinal surgery.

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Risk Factors for Postoperative Infection Following Posterior Lumbar Instrumented Arthrodesis

Cited by 226 publications

References 24 publications

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery?

Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis

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