P143. Impact of preoperative MRSA screening on infection risk in spine patients

Abstract

<h3>BACKGROUND CONTEXT</h3> Postoperative infection in the setting of spine surgery remains a significant concern for patients, surgeons, and health care institutions due to the associated morbidity, mortality, and societal costs. Prior studies have shown methicillin resistant staphylococcus aureus (MRSA) infection comprises a sizable portion of those infections. Given this information, the authors conducted a quality improvement protocol to screen and prophylactically treat elective spinal surgery patients colonized with MRSA. This study evaluates the changes in outcomes before and after the initiation of the protocol. <h3>PURPOSE</h3> The goal of this study is to compare the rates of infection before and after the implementation of a preoperative MRSA screening and treatment protocol for spine patients undergoing laminectomy or fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort review. <h3>PATIENT SAMPLE</h3> A total of 26,614 spinal fusion and laminectomy cases were included, of which there were 72 MRSA infections. <h3>OUTCOME MEASURES</h3> Incidence and relative risk of surgical infection. <h3>METHODS</h3> A retrospective cohort analysis was conducted on patients who underwent spinal fusion and laminectomy before and after the implementation of the MRSA screening and treatment protocol. The relative risk of MRSA and methicillin sensitive staphylococcus aureus (MSSA) infection before and after screening was calculated. Additionally, multivariate analysis was used to assess demographic characteristics as potential independent predictors of infection. <h3>RESULTS</h3> The relative risk of all infections, including both MRSA and MSSA, was significantly lower post protocol than before its implementation (p < 0.001 for both). Patients with infection were significantly younger, had a shorter length of procedure, higher ASA class, and more likely to be diabetic (p < 0.001 for all). Multivariate logistic regression showed that age, length of procedure, and ASA class were independent predictors of infection. <h3>CONCLUSIONS</h3> The implemented quality improvement protocol demonstrated that prophylactically treating patients colonized MRSA infection preoperatively helped reduced the rate of infection, including both MRSA and MSSA infections, after spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.