Risk Factors for the Development of Delayed Infections Following Posterior Spinal Fusion and Instrumentation in Adolescent Idiopathic Scoliosis Patients

Ho, Christine A.; Sucato, Daniel J.; Richards, B. Stephens

doi:10.1097/brs.0b013e31814b1c0b

Cited by 156 publications

(88 citation statements)

References 29 publications

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“…Ho et al reviewed 36 patients with delayed infections in adolescent idiopathic scoliosis who underwent posterior spinal fusion and found that the incidence of delayed infections was directly related to the blood transfusion. 10 Christodoulou et al found that high allogenic blood transfusion rates were significantly associated with increased acute infection in adult spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…10,23 Clinical experiences suggest that surgical time, longer fusion segments of the spine, not using postoperative drains, and increased drainage when drains are used may also correlate with delayed infection. In this retrospective, nonrandomized study we analyzed the predictors of delayed infections after spinal fusion and instrumentation in patients with scoliosis.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Shen

Liang

et al. 2014

SPI

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Object There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. Methods A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. Results The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively). Conclusions The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Shen

Liang

et al. 2014

SPI

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“…Rihn et al [30] reviewed 236 adolescent patients who underwent spinal surgery for adolescent idiopathic scoliosis to identify specific risk factors for SSI and found 7 (3%) cases of SSI and described the treatment of these infections but did not identify any specific risk factors for developing SSI. Ho et al [31] also reviewed adolescent idiopathic scoliosis patients and identified ''significant medical history'', receipt of blood transfusions and failure to use a postoperative drain as factors that increased risk of SSI but was limited by its population size. Other small studies in the literature have not been able to identify patient or surgical characteristics resulting in significantly increased risk for SSI [32][33][34].…”

Section: Introductionmentioning

confidence: 99%

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

2010

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Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case cohort analysis of all adult patients who underwent surgery for kyphosis or scoliosis, between June 1996 and December 2005, by our adult spine division in an academic institution to asses the incidence and identify risk factors for SSI. We reviewed the electronic patient records of 830 adult patients. SSI was classified as deep or superficial to the fascia. 46 (5.5%) patients were found to have a SSI with 29 patients (3.5%) having deep infections. Obesity was found to be an independent risk factor for all SSI and superficial SSI (P = 0.014 and P = 0.013). As well, a history of prior SSI was also found to be a risk factor for SSI (P = 0.041). Patient obesity and history of prior SSI lead to increased risk of infection. Since obesity was related to an increased risk of both superficial and deep SSI, counseling and treatment for obesity should be considered before elective deformity surgery.

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“…Closed-suction drains are used frequently in the setting of spinal surgery, as they are believed to reduce the incidence of post-operative hematoma, compression of the cauda equina, and resultant neurological defects [80][81][82]. The correlation between CSD and SSI has been examined in this literature, albeit with conflicting results.…”

Section: Spine Surgerymentioning

confidence: 99%

“…Ho et al [82] performed a retrospective case-control study in which adolescent patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation (PSFI) and developed a ''delayed'' SSI (n = 36) were matched with randomly selected non-infected controls (n = 90). All patients received antibiotic prophylaxis, but neither the timing nor the duration was associated with the development of delayed SSI.…”

Section: Spine Surgerymentioning

confidence: 99%

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Reiffel

Barie

Spector

2013

Surgical Infections

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Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

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Risk Factors for the Development of Delayed Infections Following Posterior Spinal Fusion and Instrumentation in Adolescent Idiopathic Scoliosis Patients

Abstract: The occurrence of a delayed infection is most likely multifactorial and is related to a positive past medical history and the use of blood transfusions. Postoperative use of a drain may be important to avoid delayed infection.

Cited by 156 publications

References 29 publications

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

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