title: Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: A retrospective case-control study.
abstract: Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann-Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted.
authors: Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University Division of Medical and Environmental Safety, Kagoshima University Medical and Dental Hospital Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka Yonemori Hospital, Yojiro, Kagoshima, Japan.
authors: Hiroyuki
authors: H
authors: Tominaga
authors: Takao
authors: T
authors: Setoguchi
authors: Hideki
authors: H
authors: Kawamura
authors: Ichiro
authors: I
authors: Kawamura
authors: Satoshi
authors: S
authors: Nagano
authors: Masahiko
authors: M
authors: Abematsu
authors: Fumito
authors: F
authors: Tanabe
authors: Yasuhiro
authors: Y
authors: Ishidou
authors: Takuya
authors: T
authors: Yamamoto
authors: Setsuro
authors: S
authors: Komiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D020878:Device Removal; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult