Abstract
PurposeAlthough the use of intraoperative computed tomography (CT)-based navigation systems is unlikely to cause intraoperative contamination more than the use of intraoperative fluoroscopy, the association between intraoperative CT/navigation and surgical site infections (SSIs) remains unclear. We investigated the incidence of SSIs and the association between intraoperative CT/navigation and SSIs for spinal surgeries.MethodsOf the 512 patients who underwent spinal surgery between April 2016 and December 2020, 304 underwent C-arm intraoperative fluoroscopy and/or Medtronic O-arm intraoperative CT/navigation system. We investigated the incidence of SSIs in patients with four techniques; no intraoperative imaging C-arm only, O-arm only, and both O- and C-arm used. Multivariate logistic analyses were conducted using the prevalence of SSIs as the dependent variable. The independent variables were age, sex, and potential confounders including preoperative Japanese Orthopaedic Association (JOA) score, use of instrumentation, C-arm, and/or O-arm.ResultsThe incidence of the SSIs in patients with no imaging, C-arm only, O-arm only, and both modalities used was 1.9%, 7.3%, 4.7%, and 8.3%, respectively. There was no significant difference in the incidence of SSIs between the four techniques. Multivariate logistic analyses showed a significant correlation between the prevalence of SSI and JOA scores (odds ratio, 0.878; 95% CI 0.759–0.990) and use of instrumentation (odds ratio, 6.241; 95% CI 1.113–34.985), but not use of O-arm.ConclusionsThe incidence of the SSIs in patients with only O-arm used was 4.7%. Preoperative clinical status and use of instrumentation, but not use of the O-arm, were associated with SSIs after spinal surgeries.
Highlights
Surgical site infections (SSIs) result in increased patient morbidity, mortality, and healthcare costs
The incidence of surgical site infections (SSIs) in spinal surgery varies widely; a large database showed an incidence of 0.72% for laminectomy with no risk factors to 8.7% for refusion of the spine in patients with three risk factors [1]
Intraoperative fluoroscopy and computed tomography (CT)-based navigation are routinely used in the operating room for a variety of spinal instrumentation surgeries
Summary
Surgical site infections (SSIs) result in increased patient morbidity, mortality, and healthcare costs. SSIs is multifactorial and is often related to a combination of preoperative, intraoperative, and postoperative factors. Intraoperative fluoroscopy and computed tomography (CT)-based navigation are routinely used in the operating room for a variety of spinal instrumentation surgeries. Previous studies have shown that the accuracy of pedicle screw placement using C-arm fluoroscopy-based image-guided techniques was higher than that of manual techniques [3, 4]. Recent studies have shown that intraoperative CT-based guidance improves the accuracy of pedicle screw placement more than does standard fluoroscopy [5, 6]. Whichever imaging systems guide the spinal instrumentation surgeries, the intraoperative fluoroscopy and CT devices need to be kept sterile while imaging with fluoroscopy and CT scanning. The study investigated the incidence and associated factors of SSIs after using Medtronic O-arm CT/ navigation system including other potential confounders for spinal surgeries
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