title: Preoperative Predictors of Spinal Infection within the National Surgical Quality Inpatient Database.
abstract: BACKGROUND
  Surgical-site infections (SSIs) are a major cause of morbidity and mortality, increasing the length and cost of hospitalization. In patients undergoing spine surgery, there are limited large-scale data on patient-specific risk factors for SSIs.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all spinal operations between 2006 and 2012. The rates of 30-day SSIs were calculated, and univariate analysis of selected preoperative risk factors was performed. Multivariate analysis was then used to identify independent predictors of SSIs.
  
  
  RESULTS
  A total of 1110 of the 60,179 patients (1.84%) had a postoperative wound infection. There were 527 (0.87%) deep and 590 (0.98%) superficial infections. Patients with infections had greater rates of sepsis, longer lengths of stay, and more return visits to the operating room. Independent predictors of infection were female sex, inpatient status, insulin-dependent diabetes, preoperative steroid use greater than 10 days, hematocrit less than 35, body mass index greater than 30, wound class, American Society of Anesthesiologists class, and operative duration.
  
  
  CONCLUSIONS
  Analysis of a large national patient database revealed many independent risk factors for SSIs after spinal surgery. Some of these risk factors can be modified preoperatively to reduce the risk of postoperative infection.
authors.affiliation: Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Lieber
authors.affiliation: New York University School of Medicine, New York, New York, USA.
authors.forename: ByoungJun
authors.initials: B
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, New York University, New York, New York, USA.
authors.forename: Russell G
authors.initials: RG
authors.lastname: Strom
authors.affiliation: Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mullin
authors.affiliation: Department of Neurosurgery, New York University, New York, New York, USA.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Frempong-Boadu
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: agarwaln@upmc.edu.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA.
authors.forename: Noojan
authors.initials: N
authors.lastname: Kazemi
authors.affiliation: Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA.
authors.forename: Monir
authors.initials: M
authors.lastname: Tabbosha
mesh_terms: D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013131:Spine / Q000601:surgery*; D013256:Steroids / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology*
chemical_list: D013256:Steroids
keywords: NSQIP; Predictors of infection; Spine; Surgical-site infection