Risk factors for surgical site infection complicating laminectomy.
OBJECTIVE
To examine risk factors for surgical site infection (SSI) following spinal surgery and to analyze the associations between a surgeon's years of operating experience and surgical specialty and patients' SSI risk.


METHODS
Case-control study.


METHODS
A tertiary care facility and a community hospital in Durham, North Carolina.


METHODS
Each case patient who developed an SSI complicating laminectomy was matched with 2 noninfected control patients by hospital, year of surgery, and National Nosocomial Infection Surveillance System risk index score.


RESULTS
Forty-one case patients with SSI complicating laminectomy and 82 matched control patients were analyzed. Nonwhite race, diabetes and an elevated body mass index (BMI) were more common among case patients than among control patients. Subjects with a BMI greater than 35 were more likely to undergo a prolonged procedure, compared with case patients who had a BMI of 35 or less. The SSI rate for patients operated on by neurosurgeons was 28%, compared with 43% for patients operated on by orthopedic surgeons (odds ratio [OR], 0.5; P=.12). The number of years of operating experience were not associated with SSI risk. Multivariate analysis revealed diabetes (OR, 4.2 [95% confidence interval {CI}, 1.1-16.3]; P=.04), BMI greater than 35 (OR, 7.1 [95% CI, 1.8-28.3]; P=.005), and laminectomy at a level other than cervical (OR, 6.7 [95% CI, 1.4-33.3]; P=.02) as independent risk factors for SSI following laminectomy.


CONCLUSIONS
Diabetes, obesity, and laminectomy at a level other than cervical are independent risk factors for SSI following laminectomy. Preoperative weight loss and tight perioperative control of blood glucose levels may reduce the risk of SSI in laminectomy patients.
Friedman
N Deborah
ND
Division of Infectious Diseases, Department of Medicine, Duke University Hospital, Durham, NC 27710, USA. friedman.deb@gmail.com
Sexton
Daniel J
DJ
Connelly
Sarah M
SM
Kaye
Keith S
KS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002983:Clinical Competence; D003920:Diabetes Mellitus; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*