title: Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery.
abstract: METHODS
  A retrospective cohort study to identify rates and analyze the risk factors for postoperative spinal wound infection.
  
  
  OBJECTIVE
  To determine significant risk factors for postoperative spinal wound infection by comparing those patients who developed a postoperative wound infection with the rest of the cohort.
  
  
  BACKGROUND
  A surgical site infection (SSI) is a common complication after spinal surgery. SSI leads to higher morbidity, mortality, and healthcare costs. To develop strategies to reduce the risk for SSI, independent risk factors for SSI should be identified.
  
  
  METHODS
  The electronic patient record of all 3174 patients who underwent orthopedic spinal surgery at out institution were abstracted. Individual patient and perioperative characteristics were stored in an electronic database.
  
  
  RESULTS
  In total, 132 (4.2%) patients were found to have an SSI with 84 having deep based infection. Estimated blood loss over 1 liter (P = 0.017), previous SSI (P = 0.012) and diabetes (P = 0.050) were found to be independent statistically significant risk factors for SSI. Obesity (P = 0.009) was found to significantly increase the risk of superficial infection, whereas anterior spinal approach decreased the risk (P = 0.010). Diabetes (P = 0.033), obesity (P = 0.047), previous SSI (P = 0.009), and longer surgeries (2-5 hours [P = 0.023] and 5 or more hours [P = 0.009]) were found to be independent significant risk factors for deep SSI.
  
  
  CONCLUSIONS
  SSI is commonly seen after spinal surgery. In our study, we identified independent risk factors for both deep and superficial SSI. Identification of these risk factors should allow us to design protocols to decrease the risk of SSE in future patients.
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA. af@pulltergunne.nl
authors.forename: Albert F
authors.initials: AF
authors.lastname: Pull ter Gunne
authors.forename: David B
authors.initials: DB
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012447:Sacrum / Q000601:surgery; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D013904:Thoracic Vertebrae / Q000601:surgery