title: Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study.
abstract: OBJECTIVE To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion. DESIGN Retrospective case-control study. SETTING Large, academic, quaternary care center. PATIENTS The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI. METHODS To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls. RESULTS During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08-0.52), duration of procedure (OR, 1.58; 95% CI, 1.29-1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00-3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37-24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64-8.78). CONCLUSIONS In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion. Infect Control Hosp Epidemiol 2017;38:348-352.
authors.affiliation: 1Division of Infectious Diseases,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Walsh
authors.affiliation: 2Department of Infection Control and Hospital Epidemiology,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Querry
authors.affiliation: 2Department of Infection Control and Hospital Epidemiology,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors.forename: Sheila
authors.initials: S
authors.lastname: McCool
authors.affiliation: 1Division of Infectious Diseases,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Galdys
authors.affiliation: 1Division of Infectious Diseases,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Shutt
authors.affiliation: 4Department of Medicine,University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Melissa I
authors.initials: MI
authors.lastname: Saul
authors.affiliation: 1Division of Infectious Diseases,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors.forename: Carlene A
authors.initials: CA
authors.lastname: Muto
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D015999:Multivariate Analysis; D009296:Nasal Cavity / Q000382:microbiology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult