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Abstract
BackgroundSurgical site infection (SSI) is a risk in every operation. Infections negatively impact patient morbidity and mortality and increase financial demands. The aim of this study was to analyse SSI and its risk factors in patients after thoracic or lumbar spine surgery.MethodsA six-year single-centre prospective observational cohort study monitored the incidence of SSI in 274 patients who received planned thoracic or lumbar spinal surgery for degenerative disease, trauma, or tumour. They were monitored for up to 30 days postoperatively and again after 1 year. All patients received short antibiotic prophylaxis and stayed in the eight-bed neurointensive care unit (NICU) during the immediate postoperative period. Risk factors for SSI were sought using multivariate logistic regression analysis.ResultsWe recorded 22 incidences of SSI (8.03%; superficial 5.84%, deep 1.82%, and organ 0.36%). Comparing patients with and without SSI, there were no differences in age (p=0.374), gender (p=0.545), body mass index (p=0.878), spine diagnosis (p=0.745), number of vertebrae (p=0.786), spine localization (p=0.808), implant use (p=0.428), American Society of Anesthesiologists (ASA) Score (p=0.752), urine catheterization (p=0.423), drainage (p=0.498), corticosteroid use (p=0.409), transfusion (p=0.262), ulcer prophylaxis (p=0.409) and diabetes mellitus (p=0.811). The SSI group had longer NICU stays (p=0.043) and more non-infectious hospital wound complications (p<0.001). SSI risk factors according to our multivariate logistic regression analysis were hospital wound complications (OR 20.40, 95% CI 7.32–56.85, p<0.001) and warm season (OR 2.92, 95% CI 1.03–8.27, p=0.044).ConclusionsContrary to the prevailing literature, our study did not identify corticosteroids, diabetes mellitus, or transfusions as risk factors for the development of SSI. Only wound complications and warm seasons were significantly associated with SSI development according to our multivariate regression analysis.
Highlights
Surgical site infection (SSI) is a risk in every operation
We studied the following risk factors of SSI: (1) parameters associated with operations; (2) use of medical devices: drainage, airways, mechanical ventilation, and catheters; (3) administration of corticosteroids; (4) transfusions, blood loss, and haemoglobin; (5) ulcer prophylaxis; (6) diabetes mellitus; (7) Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission; (8) C-reactive protein (CRP); (9) length of stay in the neurointensive care unit (NICU) and in our hospital; (10) non-infectious hospital wound complications; and (11) warm season (June, July, August)
When patients with SSI were compared with the control group, there were no significant differences in demographic data, diabetes mellitus, or ulcer prophylaxis (Table 2)
Summary
Surgical site infection (SSI) is a risk in every operation. Infections negatively impact patient morbidity and mortality and increase financial demands. Every surgery carries a risk of SSI, a complication which negatively impacts patient morbidity and mortality, increases financial demands by prolonging hospital stay, and may require further antibiotics and surgical procedures. Prudent preventive strategies have an important role in increasing postoperative patient safety and can limit the incidence of multidrug resistant strains The elimination of this complication is a priority in all surgical management and is important in spine operations, where these risks are heightened due to the frequent use of metallic implants, the nearby localization of the spinal cord, and the load-bearing function of the spine. A protective protocol includes many strategies for reducing the risk of developing an SSI This involves maintaining correct antibiotic prophylaxis, and proper hygiene throughout all stages of surgery and general care, in the operating theatre but crucially during the postoperative period until the wound has healed [1, 2]
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