Surgical Site Infection In Spinal Surgery Research Articles

Surgical Site Infections in Pediatric Spine Surgery: Comparative Microbiology of Patients with Idiopathic and Nonidiopathic Etiologies of Spine Deformity.

Surgical site infections (SSIs) are a concern in pediatric spine surgery with unusually high rates for a clean surgery and especially for patients with deformity of nonidiopathic etiology. Microbiologic differences between etiologies of spine deformities have been poorly investigated. We reviewed all cases of SSI in spinal surgery between 2007 and 2011. Characteristics of cases and of bacteria according to the etiology of the spine disease were investigated. Of 496 surgeries, we identified 51 SSIs (10.3%) in 49 patients. Staphylococcus aureus was the most frequent pathogen whatever the etiology (n = 31, 61% of infection cases). The second most frequent pathogens vary according to the etiology of the spine deformity. It was Gram-negative bacilli (GNB) in nonidiopathic cases (n = 19, 45% of cases) and anaerobe in idiopathic cases (n = 8, 38% of cases), particularly Gram-positive anaerobic cocci (n = 5, 24% of cases). Infection rate was 6.8% in cases with idiopathic spine disease (n = 21) and 15.9% in cases with nonidiopathic spine disease (n = 30). Nonidiopathic cases were more frequently male with lower weight. American Society of Anesthesiologists score was more often greater than 2, they had more frequently sacral implants and postoperative intensive care unit stay. GNB were significantly associated with a nonidiopathic etiology, low weight, younger age and sacral fusion. SSIs were polymicrobial in 31% of cases with a mean of 1.4 species per infection cases. S. aureus is the first cause of SSI in pediatric spine surgery. However, Gram-positive anaerobic cocci should be taken into account in idiopathic patients and GNB in nonidiopathic patients when considering antibiotic prophylaxis and curative treatment.

Intrawound Vancomycin Powder Decreases Staphylococcal Surgical Site Infections After Posterior Instrumented Spinal Arthrodesis

A retrospective historical cohort design. To determine what effect the addition of intrawound vancomycin powder to the prophylactic regimen of posterior instrumented spinal arthrodesis procedures has had on acute surgical site infections (SSIs). SSIs are known complications in instrumented spinal arthrodesis procedures, and are predominately caused by Staphylococcus aureus. Recent reports have suggested that placing vancomycin powder into the surgical wound before closure prevents SSIs in spinal surgery. Risk factors for SSIs in the setting of intrawound vancomycin powder use have not been previously reported on. SSI rates after 342 posterior instrumented spinal arthrodeses (October 2008-September 2011) in which intrawound vancomycin powder was used in addition to the standard antimicrobial prophylaxis (Vanco cohort) were compared with 341 posterior instrumented spinal arthrodeses (April 2005-October 2008) in which no vancomycin powder was added (non-Vanco cohort). Both 2 sample t test and χ test (Fisher where appropriate) were used for group comparisons. A subanalysis of the Vanco cohort was undertaken to identify risk factors for SSIs despite intrawound vancomycin use. There was a significant reduction in the number of acute staphylococcal SSIs in the Vanco cohort (1.1%) compared with the non-Vanco cohort (3.8%; P=0.029). Deep staphylococcal infections decreased to 0 compared with 7 in the non-Vanco cohort (2.1%; P=0.008). Deep methicillin-resistant S. aureus infections decreased to 0 compared with 5 in the non-Vanco cohort (1.5%; P=0.031). A subanalysis of the Vanco cohort identified that being discharged to an inpatient rehabilitation or skilled nursing facility was associated with developing a SSI. Intrawound vancomycin powder use has decreased the rate of acute staphylococcal SSIs in our posterior instrumented spine arthrodesis surgeries. Patients who are discharged to skilled nursing or rehabilitation facilities are at an increased risk for developing SSIs despite intrawound vancomycin use.

Surgical Site Infections in Spinal Surgery.

Surgical site infections (SSIs) are a potentially devastating complication of spine surgery. SSIs are defined by the Centers for Disease Control and Prevention as occurring within 30 days of surgery or within 12 months of placement of foreign bodies, such as spinal instrumentation. SSIs are commonly categorized by the depth of surgical tissue involvement (ie, superficial, deep incisional, or organ and surrounding space). Postoperative infections result in increased costs and postoperative morbidity. Because continued research has improved the evaluation and management of spinal infections, spine surgeons must be aware of these modalities. The controversies in evaluation and management of SSIs in spine surgery will be reviewed.

HCP-22TOPICALLY APPLIED VANCOMYCIN POWDER REDUCES THE RATE OF SURGICAL SITE INFECTION IN PATIENTS UNDERGOING CRANIOTOMIES FOR PRIMARY BRAIN TUMORS

BACKGROUND: Surgical site infections (SSI) can increase postoperative morbidity, mortality and lead to increased health care costs. The rates of SSI can be as high as 5.8% in patients undergoing craniotomies for tumors. Local application of vancomycin powder has been shown to be effective in reducing SSI in spine surgery; however, the effectiveness and safety of vancomycin powder in craniotomy in unclear. METHODS: The authors performed a retrospective chart review of all patients who underwent craniotomies for resection of primary brain glioma at the Moffitt Cancer Center from 2004-2014. A protocol consisting of 1 g of intrawound vancomycin powder application was initiated at our institution in 2010. Patient demographics (age, gender), clinical characteristics (comorbidities, steroid dose, KPS), tumor characteristics (tumor type, location), surgical factors (primary or redo, length of surgery, blood loss), SSI rates were assessed. Multivariate analysis was performed to determine risk factors associated with SSI and rates. RESULTS: A total of 864 patients underwent craniotomies for primary brain tumors. The cohorts were similar in demographics and baseline comorbidities, KPS, tumor characteristics, and surgical factors. SSI rates at 90 days were reduced after the implementation of vancomycin powder. CONCLUSIONS: The use of vancomycin powder application in craniotomy led to a reduction in SSI. No significant adverse events were observed.

Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery

ObjectSpinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. MethodsThis work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a “high definition” prospective method of surveillance was performed by the infection control (IC) department during at least 12months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). ResultsOne hundred and fifty-four patients were included. We found no hardly difference between “high definition” and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. ConclusionOur SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method.

Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure

Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure. This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups. Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5. This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case cohort analysis of all adult patients who underwent surgery for kyphosis or scoliosis, between June 1996 and December 2005, by our adult spine division in an academic institution to asses the incidence and identify risk factors for SSI. We reviewed the electronic patient records of 830 adult patients. SSI was classified as deep or superficial to the fascia. 46 (5.5%) patients were found to have a SSI with 29 patients (3.5%) having deep infections. Obesity was found to be an independent risk factor for all SSI and superficial SSI (P = 0.014 and P = 0.013). As well, a history of prior SSI was also found to be a risk factor for SSI (P = 0.041). Patient obesity and history of prior SSI lead to increased risk of infection. Since obesity was related to an increased risk of both superficial and deep SSI, counseling and treatment for obesity should be considered before elective deformity surgery.

Diabetes Associated with Increased Surgical Site Infections in Spinal Arthrodesis

Diabetes mellitus (DM) is a major risk factor for surgical site infection (SSI). Spinal surgeries are also associated with an increased risk of SSI. To confirm previous reports we evaluated the association of DM with spine infection in 195 patients who underwent elective posterior instrumented lumbar arthrodesis over a 5-year period: 30 with DM and 165 without. Other known risk factors for SSI in spinal surgery were examined: age, gender, tobacco use, body mass index, American Society of Anesthesiologists (ASA) class, intraoperative antibiotic redosing, surgical time, bone allograft use, estimated blood loss (EBL), and drain use. The adjusted relative risk of having DM for developing SSI was 4.10 (95% C.I. = 1.37-12.32). Other factors did not appear as risk factors for SSI. The data confirm DM is a risk factor for surgical site infections in spinal arthrodesis surgery. Level II, prognostic study (retrospective study).

40. Surgical Site Infection in Spinal Metastasis - Risk Factor and Countermeasure

Study Design. A retrospective review (Phase 1) and prospective clinical study (Phase 2) Objectives. The objectives of this study were to identify independent risk factors for surgical site infection (SSI) and to evaluate the positive effect of prostaglandin E1 (PGE1) to decrease the risk of SSI in patients with spinal metastasis. Summary of Background Data. Surgery for spinal metastasis is associated with an increased risk of SSI. Although previous reports have evaluated risk factors of SSI for spinal metastasis, most of the studies lack multivariate analysis. A recent study demonstrated the utility of PGE1 in decreasing wound complications in patients with prior irradiation. The role of PGE1 in surgery for spinal metastasis has not been previously evaluated. Methods. 110 patients with spinal metastasis were retrospectively reviewed (phase 1). Risk factors for SSI were analyzed using logistic regression. Phase 2 was a prospective clinical trial investigating the utility of PGE1 at reducing the rate of SSI. 94 patients for with spinal metastasis were treated at our institute. The infection rate and risk factors identified in phase 1 and 2 were compared. Results. The rate of SSI during Phase 1 was 7.1%. Independent risk factors identified by multivariate logistic regression were diabetes, and preoperative irradiation. The rate of SSI for patients who had irradiation before surgery was 32%, while the rate for patients without irradiation was 1.1%. This difference was statistically significant. The rate of SSI in Phase 2 was 3.1%. In Phase 2 patients who received preoperative irradiation, the rate of SSI was 4.5%. The difference between Phase 1 and Phase 2 was statistically significant. Conclusions: This study identified diabetes and preoperative irradiation to be independent risk factors for SSI in patients with spinal metastasis. PGE1 administration was found to significantly decrease the incidence of SSI in patients with spinal metastasis who underwent preoperative irradiation. Introduction The purposes of surgical treatment for spinal metastasis are to avoid recurrence of the tumor, and to control spinal paralysis to maintain the patient's quality of life until the last moment. On the other hand, patients with spinal metastasis might have poor nutritional status and be prone to immunosupression from disease or treatments. Hence, the surgery for spinal metastasis is still controversial because it has potential risks of postoperative systemic complications. Recent literatures have reported excellent functional outcomes after the surgery for spinal metastasis with falling morbidity rates , although, the rate of complication remains relatively high compared to other spinal surgeries. Wise et al reported that the rate of complication was 25%. In all these reports, a major cause of morbidity was surgical site infection (SSI). SSI is one of the serious complications and may compromise the quality of outcome. A variety of risk factors for SSI in spinal surgery have been reported. Patient characteristics reported to increase the risk of SSI following spinal surgery are advanced age, preoperative malnutrition, presence of diabetes, preoperative or perioperative steroid therapy, and preoperative adjunctive therapy including chemotherapy or irradiation at the surgical site. Surgery-related risk factors reported to be associated