Surgical site infections in spinal neurosurgery

Abstract

The review presents current data on the problem of surgical site infections in spinal neurosurgery. Infectious complications are the most common cause of unsatisfactory results of surgical treatment and prolonged hospital stay of patients after spinal surgery. Clinical and economic analysis shows that each case of infection at the site of surgical intervention causes additional 7.3 days of hospital stay in the postoperative period and $3152 extra costs per patient. According to the world literature, the incidence of wound infection in spinal neurosurgery varies from 0.7 to 11.9%. The main risk factors for this complication are long period from the moment of hospitalization to the operation, significant blood loss and long duration of surgical intervention. In the article, special role in the development of wound infection is given to the malnutrition syndrome. Patients suffering from this syndrome are considered to be at high risk of surgical site infections developing. Insufficient amounts of protein and energy substances are the cause of disturbed reparative processes in the wound and decreased level of immune defense. Diagnosis of wound infection is based on a comprehensive analysis of clinical and laboratory-instrumental research methods. The review presents current data on the pathogens of surgical site infections, regimens of antibiotic prophylaxis and effective methods of treatment (local and systemic antibiotic therapy, vacuum-assisted closure, flow-washing drainage, hyperbaric oxygenation). Undoubtedly, early diagnosis and correctly chosen management of a patient allows to reverse signs of wound infection and to avoid unfavorable clinical outcomes after surgical interventions on the spine.