Risk Factors for Spinal Surgical-Site Infections in a Community Hospital: A Case–Control Study

Apisarnthanarak, Anucha; Jones, Marilyn C.; Waterman, Brian; Carroll, C.; Bernardi, Robert J.; Fraser, Victoria J.

doi:10.1086/502112

Cited by 82 publications

(66 citation statements)

References 27 publications

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“…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%

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: Literature Search and Systematic Review Resultsmentioning

confidence: 99%

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

2013

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“…As one of the moderate-evidence factors, larger blood loss may be directly associated with blood transfusion, which results in immune suppression in the recipient [46] and an increased risk of infection for all types of surgery [4]. Previous surgery may result in bowel and bladder dysfunction or complex tissue reconstruction, which to some extent may increase the risk of SSI after The use of glue to cement the dural patch 13 [3] Postoperative incontinence 41 [39] Surgery for tumor resection 41 [39] Complete neurologic deficit 12 [48] Steroid therapy 22 [61] Extended preoperative hospitalization 22 [61] Indication for surgery 9 [34] Conflicting evidence The number of resident surgeons participating in the operative procedure 212 [5,26,40] spinal surgery. We also identified 31 limited-evidence factors, and only the number of resident surgeons participating in the operative procedure was identified as a conflicting-evidence factor.…”

Section: Discussionmentioning

confidence: 99%

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

Xing

et al. 2012

Eur Spine J

138

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Objective To identify the independent risk factors, based on available evidence in the literature, for patients developing surgical site infections (SSI) after spinal surgery. Methods Non-interventional studies evaluating the independent risk factors for patients developing SSI following spinal surgery were searched in Medline, Embase, Sciencedirect and OVID. The quality of the included studies was assessed by a modified quality assessment tool that had been previously designed for observational studies. The effects of studies were combined with the study quality score using a best-evidence synthesis model. Results Thirty-six observational studies involving 2,439 patients with SSI after spinal surgery were identified. The included studies covered a wide range of indications and surgical procedures. These articles were published between 1998 and 2012. According to the quality assessment criteria for included studies, 15 studies were deemed to be high-quality studies, 5 were moderate-quality studies, and 16 were low-quality studies. A total of 46 independent factors were evaluated for risk of SSI. There was strong evidence for six factors, including obesity/BMI, longer operation times, diabetes, smoking, history of previous SSI and type of surgical procedure. We also identified 8 moderate-evidence, 31 limited-evidence and 1 conflictingevidence factors. Conclusion Although there is no conclusive evidence for why postoperative SSI occurs, these data provide evidence to guide clinicians in admitting patients who will have spinal operations and to choose an optimal prophylactic strategy. Further research is still required to evaluate the effects of these above risk factors.

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“…In the setting of a surgical site infection, patients are likely to require intravenous (IV) antibiotics, a prolonged hospital stay 8 , and operative debridement. The deleterious clinical effects of surgical site infection are associated with an increase in total costs 1 .…”

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confidence: 99%

“…Estimates of the rate of surgical site infection following spine surgery have ranged from 1.9% to 13.8% [2][3][4][5][6][7][8]14 , depending on study design. Most studies on surgical site infection have included a retrospective analysis with matched control groups and have not adjusted for confounding factors [3][4][5][6][7] .…”

mentioning

confidence: 99%

Using the Spine Surgical Invasiveness Index to Identify Risk of Surgical Site Infection

Cizik

Lee

Martin

et al. 2012

Journal of Bone and Joint Surgery

117

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Risk Factors for Spinal Surgical-Site Infections in a Community Hospital: A Case–Control Study

Abstract: Dural tear and the use of glue should be evaluated as potential risk factors for spinal surgical-site infection. Systematic observation for potential lapses in sterile technique and surgical processes that may increase the risk of infection may help prevent spinal surgical-site infection.

Cited by 82 publications

References 27 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

A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

Using the Spine Surgical Invasiveness Index to Identify Risk of Surgical Site Infection

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