Deep-wound and organ-space infection after surgery for degenerative spine disease: an analysis from 2006 to 2012.
OBJECTIVE
To study the incidence and risk factors of deep-wound and organ-space surgical site infection (SSI) following surgery for degenerative spine disease.


METHODS
Data from the American College of Surgeons National Surgical Quality Improvement Program were obtained for the years 2006-2012. All adult patients over 40 years of age who underwent elective cervical or lumbar spine surgery for degenerative spine disease were identified. Rates of deep-wound and organ-space SSI were calculated for each procedure. A multivariate logistic regression analysis was conducted to identify independent risk factors for SSI development.


RESULTS
A total of 36,440 patients were identified, with 7,627 patients (20.93%) undergoing cervical spine surgery and 28,813 patients (79.07%) undergoing lumbar spine surgery. The overall rate of SSI was 0.72% (n = 264); there were 189 deep-wound infections (0.52%) and 75 organ-space infections (0.21%). The highest rates of SSI were for patients undergoing a posterolateral fusion of the lumbar spine (1.04%), followed by patients undergoing a posterior cervical decompression (1.02%); the lowest rates were for patients undergoing cervical disc replacement (0.00%). The multivariate analysis revealed that chronic steroid use (OR 3.66) and increasing operative time (OR 1.002) were the strongest independent risk factors for SSI development in the cervical spine, and renal morbidity (OR 3.93), hemato-oncological morbidity (OR 2.55), and chronic steroid use (2.04) were the strongest risk factors for lumbar SSI. Additionally, patients with a SSI had longer lengths of stay and higher mortality rates (0.76%) when compared to patients without a SSI (0.09%).


CONCLUSIONS
Deep-wound and organ-space infections are severe complications in patients undergoing spine surgery. In this study of a multi-centre and prospectively collected database, the rate of SSI was 0.72%. Patients with renal disorders, chronic steroid use, hemato-oncological disease, and diabetes, among others, had significantly higher odds of SSI development.
a Department of Neurosurgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Rafael
R
De la Garza-Ramos
a Department of Neurosurgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Nicholas B
NB
Abt
b Department of Neurosurgery , Mayo Clinic , Rochester , MN , USA.
Panagiotis
P
Kerezoudis
b Department of Neurosurgery , Mayo Clinic , Rochester , MN , USA.
Brandon A
BA
McCutcheon
a Department of Neurosurgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Ali
A
Bydon
c Department of Neurosurgery , Warren Alpert Medical School, Brown University , Providence , RI , USA.
Ziya
Z
Gokaslan
b Department of Neurosurgery , Mayo Clinic , Rochester , MN , USA.
Mohamad
M
Bydon
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*
NSQIP; Spine; cervical; deep-wound infection; fusion; lumbar; organ-space infection; surgery; surgical site infection