Abstract
ABSTRACT Objective: To identify the factors associated with postoperative infections in spinal surgery. Methods: Descriptive, retrospective, cross-sectional study conducted in the spine surgery department of the Medical Unit of High Specialty (UMAE) at the Hospital of Traumatology and Orthopedics Lomas Verdes, Mexican Institute of Social Security (IMSS) between January 01, 2013 and June 30, 2014 through medical records of the service and the records of clinical care. Data were gathered in accordance with the records of patients with infection after spinal surgery. The factors considered were age group, etiologic agent, surgical site, type of treatment, bleeding volume and pharmacotherapy. Frequency and descriptive statistic was conducted. The rank sum test with the Wilcoxon test for a single sample was performed in different measurements; Pearson's correlation was calculated and all p<0.05 values were considered significant. Results: The sample was composed of 14 patients of which 11 were female (78.6%) and 3 male (21.4%) with predominance of surgical area in the lumbar and dorsolumbar region. There was a significant correlation between the surgical time and the amount of bleeding with p<0.001. Conclusions: It was clear that the infections present in patients after spinal surgery are multifactorial. However, in this study the correlation between time of surgery and bleeding amount had the highest importance and relevance.
Highlights
Most surgical instrumentation techniques have enabled improved outcomes in patients with various difficult-to-manage diseases of the spine
There is a variety of risk factors for infections following spine surgery and they can be divided into factors dependent on the patient and factors dependent on the surgeon.[2]
Our results show that in our environment the most common etiological agent was S. epidermidis followed by S. aureus and less frequently by S. haemolyticus, reflecting an inverse relationship to the results reported in the literature
Summary
Most surgical instrumentation techniques have enabled improved outcomes in patients with various difficult-to-manage diseases of the spine. Postoperative infections can have devastating sequelae, including instrumentation failure, osteomyelitis, pseudoarthrosis, and significant medical problems These infections are often difficult to diagnose and treat.[1] Postoperative spinal infections are a potential problem in many cases following successful surgical procedures.[2] It is reported that they can occur in between 0.7% and 12% of patients, ranging from 1% for lumbar discectomies to 1-2% for cervical spine surgery to 6% or more for lumbar spine surgery with instrumentation and/or fusion, resulting in a rise in morbidity, mortality, and high health care costs.[2,3] There is a variety of risk factors for infections following spine surgery and they can be divided into factors dependent on the patient and factors dependent on the surgeon.[2] Host factors include age, obesity, urinary incontinence, smoking, malnutrition, complete neurological deficit, revision surgery, use of non-steroidal anti-inflammatory medication, posterior surgical approach, tumor resection, increased bleeding above the permissible, prolonged surgical time, use of instrumentation, multilevel surgery, and/or vertebral fusion, and the presence of 3 or more comorbid illnesses.[3,4,5] Included among the extrinsic factors are the absence of preoperative antibiotics, inadequate use of sterile techniques, and increased traffic in the operating room.[5,6] In addition, yet unproven factors using fluoroscopy and drainage are mentioned.[2] Infections can occur both in deep and superficial tissues. Recognizing the preoperative risk factors can optimize and, in some cases, modify the preoperative condition of the patient.[1,8]
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