The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders

Abstract

Background:Few reports in the literature have described the long-term outcome of postoperative infection from the patient perspective. The aim of the present study was to determine if complicated surgical site infection (SSI) affects functional recovery and surgical outcomes up to 2 years after posterior instrumented thoracolumbar surgery for the treatment of degenerative disorders.Methods:This retrospective cohort study involved patients who had been enrolled in a previous randomized controlled trial that examined antibiotic use for open posterior multilevel thoracolumbar or lumbar instrumented fusion procedures. In the present study, patients who had SSI (n = 79) were compared with those who did not (n = 456). Patient-reported outcome measures (PROMs) included the Oswestry Disability Index (ODI), leg and back pain scores on a numeric rating scale, Short Form-12 (SF-12) summary scores, and satisfaction with treatment at 1.5, 3, 6, 12, and 24 months. Surgical outcomes included adverse events, readmissions, and additional surgery.Results:The median time to infection was 15 days. Of the 535 patients, 31 (5.8%) had complicated infections and 48 (9.0%) had superficial infections. Patients with an infection had a higher body mass index (BMI) (p = 0.001), had more commonly received preoperative vancomycin (p = 0.050), were more likely to have had a revision as the index procedure (p = 0.004), had worse preoperative mental functioning (mental component summary score, 40.7 ± 1.6 versus 44.1 ± 0.6), had more operatively treated levels (p = 0.024), and had a higher rate of additional surgery (p = 0.001). At 6 months after surgery, patients who developed an infection scored worse on the ODI by 5.3 points (95% confidence interval [CI], 0.4 to 10.1 points) and had worse physical functioning by −4.0 points (95% CI, −6.8 to −1.2 points). Comparison between the groups at 1 and 2 years showed no difference in functional outcomes, satisfaction with treatment, or the likelihood of achieving the minimum clinically important difference (MCID) for the ODI.Conclusions:SSI more than doubled the post-discharge emergency room visit and additional surgery rates. Patients with SSI initially (6 months) had poorer overall physical function representing the delay to recovery; however, the negative impact resolved by the first postoperative year.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Outcome Horizon Is Optimistic After Infection

“…The authors found that the development of SSI did not lead to a difference in outcome scores at 1-year follow-up from spinal fusion. These findings mirror those recently published by Urquhart et al , 3 who report the negative impact of SSI after surgery resolves at 1-year follow-up using the same outcome measures.…”

Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?—An ambispective study

“…There have been many articles on the topical of local vancomycin to reduce the risk of infection after orthopaedic surgery [3,38,39]. Moreover, vancomycin impregnated bone graft has been also widely used in spinal surgery [40][41][42]. Therefore, a prospective randomized study with an adequate patient number is needed to clarify the benefits of vancomycin impregnated autogenous bone graft and bone substitute on preventing DSSI following degenerative lumbar spine fusion surgery.…”

Clinical relevance of occult infections in spinal pseudarthrosis revision

“…Our re-revision risks tended to be lower (22% versus 56%) in favor of the occult infection group, even though the difference was not statistically significant. In general, surgical site infections not only require enduring long-term antibiotic treatment, but are also associated with poorer clinical outcome scores and higher risk for revision surgery [ 35 , 36 ]. Therefore, we expected that the occultly infected patients would have lower PROMs together with higher re-revision risk when compared to their noninfected study group.…”