title: Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology.
abstract: BACKGROUND
  Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are known to prevent it.
  
  
  OBJECTIVE
  The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES.
  
  
  METHODS
  This is a retrospective clinical study.
  
  
  METHODS
  One hundred twenty-five patients who underwent TES for vertebral tumor were evaluated.
  
  
  METHODS
  Incidence rate of SSI, risk factors for SSI after TES, and safety of iodine-supported spinal instruments were the outcome measures.
  
  
  METHODS
  Risk factors for SSI were analyzed using logistic regression. In recent 69 patients with iodine-supported spinal instruments, the thyroid hormone levels in the blood were examined to confirm if iodine from the implant influenced thyroid function. Postoperative radiological evaluations were performed regularly.
  
  
  RESULTS
  The rate of SSI was 6.4% (8/125 patients). By multivariate logistic regression, combined anterior and posterior approach and nonuse of iodine-supported spinal instruments were associated with an increased risk of SSI. The rate of SSI without iodine-supported spinal instruments was 12.5%, whereas the rate with iodine-supported spinal instruments was 1.4%. This difference was statistically significant. There were no detected abnormalities of thyroid gland function with the use of iodine-supported instruments. Among the 69 patients with iodine-supported spinal instruments, 2 patients required additional surgery because of instrument failure. However, there were no obvious involvements with the use of iodine-supported spinal instruments.
  
  
  CONCLUSIONS
  This study identified combined anterior and posterior approach and nonuse of iodine-supported spinal instruments to be independent risk factors for SSI after TES. Iodine-supported spinal instrument was extremely effective for prevention of SSI in patients with compromised status, and it had no detection of cytotoxic or adverse effects on the patients.
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Shinmura
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yokogawa
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ishii
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Shirai
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan. Electronic address: tsuchi@med.kanazawa-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
keywords: Iodine-supported spinal instrument; Multivariate analysis; Risk factor; Surgical site infection; Total en bloc spondylectomy; Vertebral tumor