Risk factors for deep surgical site infections after spinal fusion.
Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case-control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6-8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus. All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways. High-risk patients should be informed about the increased risk of complications.
Schimmel
J J P
JJ
Department of Research Development and Education, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands. j.schimmel@maartenskliniek.nl
Horsting
P P
PP
de Kleuver
M
M
Wonders
G
G
van Limbeek
J
J
D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology
Cochrane Database Syst Rev. 2008 Oct 08;(4):CD006216
18843708
J Am Acad Orthop Surg. 2008 Jun;16(6):330-7
18524984
J Hosp Infect. 2006 Mar;62(3):319-26
16406851
Spine (Phila Pa 1976). 2009 Mar 15;34(6):578-83
19240667
Spine J. 2009 Feb;9(2):142-6
18619911
Surg Neurol. 2008 Dec;70(6):622-7; discussion 627
18207532
Clin Orthop Relat Res. 1992 Nov;(284):99-108
1395319
J Neurosurg. 2003 Mar;98(2 Suppl):149-55
12650399
Spine (Phila Pa 1976). 2005 Jun 15;30(12):1460-5
15959380
Surg Infect (Larchmt). 2006;7 Suppl 1:S19-22
16834543
J Spinal Disord. 2000 Oct;13(5):422-6
11052352
Spine (Phila Pa 1976). 2007 Sep 15;32(20):2272-7
17873822
Cochrane Database Syst Rev. 2009 Jul 08;(3):CD006806
19588404
Clin Orthop Relat Res. 2009 Jul;467(7):1670-3
19225851
Infect Control Hosp Epidemiol. 2007 May;28(5):557-63
17464915
Clin Infect Dis. 2009 Apr 1;48(7):922-30
19231978
J Bone Joint Surg Am. 2008 Jan;90(1):62-9
18171958
J Am Acad Orthop Surg. 2008 May;16(5):283-93
18460689
Br J Surg. 2009 May;96(5):451-61
19358172
Spine (Phila Pa 1976). 2004 Apr 15;29(8):938-45
15083000