title: Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults.
abstract: BACKGROUND
  Surgical site infection is a serious and significant complication after spinal surgery and is associated with high morbidity rates, high healthcare costs and poor patient outcomes. Accurate identification of risk factors is essential for developing strategies to prevent devastating infections. The purpose of this study was to identify independent risk factors for surgical site infection among posterior thoracic and/or lumbar spinal surgery in adult patients using a prospective multicenter surveillance research method.
  
  
  METHODS
  From July 2010 to June 2012, we performed a prospective surveillance study in adult patients who had developed surgical site infection after undergoing thoracic and/or lumbar posterior spinal surgery at 11 participating hospitals. Detailed preoperative and operative patient characteristics were prospectively recorded using a standardized data collection format. Surgical site infection was based on the definition established by the Centers for Disease Control and Prevention.
  
  
  RESULTS
  A total of 2,736 consecutive adult patients were enrolled, of which 24 (0.9%) developed postoperative deep surgical site infection. Multivariate regression analysis indicated four independent risk factors. Preoperative steroid therapy (P = 0.001), spinal trauma (P = 0.048) and gender (male) (P = 0.02) were statistically significant independent patient-related risk factors, whereas an operating time ≥3 h (P < 0.001) was a surgery-related independent risk factor.
  
  
  CONCLUSIONS
  Preoperative steroid therapy, spinal trauma, male gender and an operating time ≥3 h were independent risk factors for deep surgical site infection after thoracic and/or lumbar spinal surgery in adult patients. Identification of these risk factors can be used to develop protocols aimed at decreasing the risk of surgical site infection.
authors.affiliation: Department of Orthopaedic Surgery, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan, s-ogihara@sagamihara-hosp.gr.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Toru
authors.initials: T
authors.lastname: Maruyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.forename: Kota
authors.initials: K
authors.lastname: Miyoshi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Azuma
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.forename: Motoaki
authors.initials: M
authors.lastname: Murakami
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kawamura
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hara
authors.forename: Sei
authors.initials: S
authors.lastname: Terayama
authors.forename: Jiro
authors.initials: J
authors.lastname: Morii
authors.forename: So
authors.initials: S
authors.lastname: Kato
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D013122:Spinal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000601:surgery*; D055815:Young Adult