Seasonal Effects on Surgical Site Infections Following Spine Surgery

Abstract

Studies investigating seasonality as a risk factor for surgical site infections (SSIs) after spine surgery show mixed results. This study used national data to analyze seasonal effects on spine surgery SSIs. National Surgical Quality Improvement Program data (2011-2018) were queried for posterior cervical fusions (PCFs), cervical laminoplasties, posterior lumbar fusions (PLFs), lumbar laminectomies, and deformity surgeries. Patients aged >89 and procedures for tumors, fractures, infections, and nonelective indications were excluded. Patients were divided into warm (admitted April-September) and cold (admitted October-March) seasonal groups. End points were SSIs and reoperations for wound débridement/drainage. Stratified analyses were performed by surgery type and pre-versus postdischarge infections. Overall (N= 208,291), SSIs were more likely in the warm season (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.08-1.23, P < 0.0001) and for PCFs (OR 1.40,95% CI 1.08-1.80, P= 0.011), PLFs (OR 1.15, 95% CI 1.04-1.28, P= 0.006), and lumbar laminectomies (OR 1.13, 95% CI 1.03-1.25, P= 0.014). Postdischarge infections were also more likely in the warm season overall (OR 1.15, 95% CI 1.07-1.23, P < 0.0001) and for PCFs (OR 1.32, 95% CI1.01-1.73, P= 0.041), PLFs (OR 1.14, 95% CI 1.03-1.27, P= 0.014), and lumbar laminectomies (OR 1.15, CI 1.04-1.27, P= 0.007). In-hospital infections were more likely during the warm season only for PCFs (OR 2.54, 95% CI 1.06-6.10, P= 0.037). Reoperations for infection were more likely during the warm season for PLFs (OR 1.29, 95% CI 1.08-1.54, P= 0.005). PCF, PLF, and lumbar laminectomy performed during the warm season had significantly higher odds of SSI, especially postdischarge SSIs. Reoperation rates for wound management were significantly increased during the warm season for PLFs. Identifying seasonal causes merits further investigation and may influence surgeon scheduling and expectations.