title: Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?
abstract: METHODS
  Retrospective review of prospectively collected data.
  
  
  OBJECTIVE
  To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI.
  
  
  BACKGROUND
  SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications.
  
  
  METHODS
  All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI.
  
  
  RESULTS
  A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS.
  
  
  CONCLUSIONS
  Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.
authors.affiliation: Mumbai Spine Scoliosis & Disc Replacement Centre, Orthopaedics Department Bombay Hospital and Medical Research Centre, Mumbai, Mumbai, India.
authors.forename: Arvind Gopalrao
authors.initials: AG
authors.lastname: Kulkarni
authors.affiliation: Mumbai Spine Scoliosis & Disc Replacement Centre, Orthopaedics Department Bombay Hospital and Medical Research Centre, Mumbai, Mumbai, India.
authors.forename: Ravish Shammi
authors.initials: RS
authors.lastname: Patel
authors.affiliation: Mumbai Spine Scoliosis & Disc Replacement Centre, Orthopaedics Department Bombay Hospital and Medical Research Centre, Mumbai, Mumbai, India.
authors.forename: Shumayou
authors.initials: S
authors.lastname: Dutta
keywords: Decompression; Discectomy; Fusion; Minimally invasive surgical procedures; Surgical wound infections