Risk Factor Analysis of Deep Surgical Site Infection After Posterior Instrumented Fusion Surgery for Spinal Trauma: A Multicenter Observational Study

Abstract

Surgical site infection (SSI) is a dire complication in spinal surgeries, resulting in reoperation, prolonged hospitalization, and increased expenses. Patients with traumatized spine have been reported to have a high risk of postoperative SSI. Precise identification of risk factors associated with SSI can be helpful in its prevention. However, there are only a limited number of studies investigating risk factors of SSI after posterior instrumented fusion for traumatized spine. From July 2010 to June 2015, we conducted an observational study on deep SSI after posterior instrumented fusion surgery for spinal trauma in adult patients at 10 research hospitals. Detailed clinical data were prospectively collected using a standardized data collection chart and were retrospectively analyzed. SSI was diagnosed based on the definition by the Centers for Disease Control and Prevention. A total of 623 consecutive adult patients were enrolled in this study, of which 20 (3.2%) developed deep SSI. According to multivariate regression analysis, surgery at academic hospitals (P= 0.004) and an American Society of Anesthesiologists (ASA) score ≥3 (P= 0.017) were independent predictors of deep SSI after posterior instrumented fusion surgery for spinal trauma. The complexity of patients and resident involvement in surgeries may be greater at academic than at nonacademic hospitals. ASA score can be considered as an accessible and comprehensive tool for surgeons to preoperatively gauge the potential risk of SSI, a complex clinical entity. The results of this study can improve clinicians' risk perception in those undergoing posterior fusion for spinal trauma.