Risk factors for spinal surgical-site infections in a community hospital: a case-control study.
OBJECTIVE
To characterize risk factors for surgical-site infection after spinal surgery.


METHODS
A case-control study.


METHODS
A 113-bed community hospital.


METHODS
From January 1998 through June 2000, the incidence of surgical-site infection in patients undergoing laminectomy, spinal fusion surgery, or both increased at community hospital A. We compared 13 patients who acquired surgical-site infections after laminectomy, spinal fusion surgery, or both with 47 patients who were operated on during the same time period but did not acquire a surgical-site infection. Information collected included demographics, risk factors, personnel involved in the operations, length of hospital stay, and hospital costs.


RESULTS
Of 13 case-patients, 9 (69%) were obese, 9 (69%) had spinal compression, 5 (38.5%) had a history of tobacco use, and 4 (31%) had diabetes. Oxacillin-sensitive Staphylococcus aureus (6 of 13; 46%) was the most common organism isolated. Significant risk factors for postoperative spinal surgical-site infection were dural tear during the surgical procedure and the use of glue to cement the dural patch (3 of 13 [23%] vs 1 of 47 [2.1%]; P = .02) and American Society of Anesthesiologists risk class of 3 or more (6 of 13 [46.2%] vs 7 of 47 [15%]; P = .02). Case-patients were more likely to have prolonged length of stay (median, 16 vs 4 days; P< .001). The average excess length of stay was 11 days and the excess cost per case was $12,477.


CONCLUSIONS
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.
Apisarnthanarak
Anucha
A
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Jones
Marilyn
M
Waterman
Brian M
BM
Carroll
Cathy M
CM
Bernardi
Robert
R
Fraser
Victoria J
VJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects; D016022:Case-Control Studies; D004388:Dura Mater / Q000293:injuries; D005260:Female; D017721:Hospital Costs; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology
D001843:Bone Cements