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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 ide...
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Low back pain (LBP) is a common complaint with various studies indicating a point prevalence of from 12% to 33%, a one-year prevalence from 22% to 65%, and lifetime prevalence from 11% to 84%. 1 Most Western adults complaining of LBP do not seek professional treatment, but those with chronic spinal disorders have worse scores for measurement of phy...
Citations
... Haemorrhagic events are a feared complication after spine surgery due to their potentially drastic consequences. Although extraspinal haematomas can adversely impact the post-operative course by increasing the time to recovery, length of hospital stay and risk for wound complications [8][9][10], EDH are particularly concerning, as they may lead to irreversible neurological damage. Our finding that OAC did not increase the risk of EDH may thus be considered reassuring and is in line with results from two previous smaller investigations that did not find any association between well-controlled OAC use and post-operative rates of EDH [11,12]. ...
The aim of this study was to investigate the risks and outcomes of patients with long-term oral anticoagulation (OAC) undergoing spine surgery.
All patients on long-term OAC who underwent spine surgery between 01/2005 and 06/2015 were included. Data were prospectively collected within our in-house Spine Surgery registry and retrospectively supplemented with patient chart and administrative database information. A 1:1 propensity score-matched group of patients without OAC from the same time interval served as control. Primary outcomes were post-operative bleeding, wound complications and thromboembolic events up to 90 days post-surgery. Secondary outcomes included intraoperative blood loss, length of hospital stay, death and 3-month post-operative patient-rated outcomes.
In comparison with the control group, patients with OAC (n = 332) had a 3.4-fold (95%CI 1.3–9.0) higher risk for post-operative bleeding, whereas the risks for wound complications and thromboembolic events were comparable between groups. The higher bleeding risk was driven by a higher rate of extraspinal haematomas (3.3% vs. 0.6%; p = 0.001), while there was no difference in epidural haematomas and haematoma evacuations. Risk factors for adverse events among patients with OAC were mechanical heart valves, posterior neck surgery, blood loss > 1000 mL, age, female sex, BMI > 30 kg/m2 and post-operative PTT levels. At 3-month follow-up, most patients reported favourable outcomes with no difference between groups.
Although OAC patients have a higher risk for complications after spine surgery, the risk for major events is low and patients benefit similarly from surgery.
... Surgical site infections are one category that can result in significant morbidity and mortality. For ASD procedures, surgical site infections have been reported in up to 10% of cases, with risk factors for infection including prior history of a site infection and elevated body mass index [104][105][106][107]. A systems-based approach that incorporates patient comorbidity optimization, timely administration of antibiotics, surgical sterile technique, and post-operative wound care has been shown to reduce the incidence of surgical site infections [108]. ...
Background:
Surgical intervention is a critical tool to address adult spinal deformity (ASD). Given the evolution of spinal surgical techniques, we sought to characterize developments in ASD correction and barriers impacting clinical outcomes.
Methods:
We conducted a literature review utilizing PubMed, Embase, Web of Science, and Google Scholar to examine advances in ASD surgical correction and ongoing challenges from patient and clinician perspectives. ASD procedures were examined across pre-, intra-, and post-operative phases.
Results:
Several factors influence the effectiveness of ASD correction. Standardized radiographic parameters and three-dimensional modeling have been used to guide operative planning. Complex minimally invasive procedures, targeted corrections, and staged procedures can tailor surgical approaches while minimizing operative time. Further, improvements in osteotomy technique, intraoperative navigation, and enhanced hardware have increased patient safety. However, challenges remain. Variability in patient selection and deformity undercorrection have resulted in heterogenous clinical responses. Surgical complications, including blood loss, infection, hardware failure, proximal junction kyphosis/failure, and pseudarthroses, pose barriers. Although minimally invasive approaches are being utilized more often, clinical validation is needed.
Conclusions:
The growing prevalence of ASD requires surgical solutions that can lead to sustained symptom resolution. Leveraging computational and imaging advances will be necessary as we seek to provide comprehensive treatment plans for patients.
... Colonization during the initial surgery, contiguous spread or hematogenous pathways have been proposed as mechanisms how bacteria could reach implants to form a biofilm [2,8,30,33]. Several risk factors are associated with the occurrence of acute SSI in spine surgery, such as spinal trauma [32] or history of infection in the surgical site [7,14,31]. Not surprisingly, we demonstrated that perioperative infectious complications greatly influenced the likelihood of a positive result in SFC. ...
Purpose
Low-virulent microorganisms identified on pedicle screws by sonication fluid culture (SFC) are an important cause of implant loosening. While sonication of explanted material improves the detection rate, the risk of contamination exists and no standardized diagnostic criteria for chronic low-grade spinal implant-related infection (CLGSII) are stablished. Besides, the role of serum C-reactive protein (CRP) and procalcitonin (PCT) in CLGSII has not been adequately investigated.
Methods
Blood samples were collected prior to implant removal. To increase sensitivity, the explanted screws were sonicated and processed separately. Patients exhibiting at least one positive SFC were classified in the infection group (loose criteria). To increase specificity, the strict criteria only considered multiple positive SFC (≥ 3 implants and/or ≥ 50% of explanted devices) as meaningful for CLGSII. Factors which might promote implant infection were also recorded.
Results
Thirty-six patients and 200 screws were included. Among them, 18 (50%) patients had any positive SFCs (loose criteria), whereas 11 (31%) patients fulfilled the strict criteria for CLGSII. Higher serum protein level was the most accurate marker for the preoperative detection of CLGSSI, exhibiting an area under the curve of 0.702 (loose criteria) and 0.819 (strict criteria) for the diagnosis of CLGSII. CRP only exhibited a modest accuracy, whereas PCT was not a reliable biomarker. Patient history (spinal trauma, ICU hospitalization and/or previous wound-related complications) increased the likelihood of CLGSII.
Conclusion
Markers of systemic inflammation (serum protein level) and patient history should be employed to stratify preoperative risk of CLGSII and decide the best treatment strategy.
... This information can change patient management, and the current literature suggests that superficial infections may predict future deep infections. [5][6][7] To address this point, we created a table describing each wound infection case as deep or superficial (Table 1). In addition, the authors note that our wound complication rates are not consistent with those in the existing literature. ...
... When these fevers appeared, we performed many laboratory tests to exclude the possibility of deep infection but failed to confirm the etiology of the fever in most cases. 5,6 The rate of surgical site infection has been reported to range from 0.7% to 12%, [7][8][9] and the rate in our hospital was approximately 0.1%. If an infection occurred, it would be difficult for a patient to recover. ...
Background:
Many inpatients encounter a fever in the first 24 h after drainage removal. It is costly to exclude the possibility of deep infection and cultures usually fail to identify the etiology. We hypothesize that the fever is caused by a normal inflammatory response and tested whether the prophylactic use of acetaminophen could reduce the fever rate.
Methods:
This was a prospectively randomized clinical trial performed from July 2019 to January 2020. A total of 183 consecutive patients undergoing lumbar spine surgery were prospectively randomized into two groups. Ninety-one patients were randomized into the study group; they received oral acetaminophen before removal of the drainage tubes and a second dose at 8 p.m. on the same day. The remaining 92 patients were placed in the control group, and they were given routine treatment without acetaminophen. The two groups were compared for differences in age, sex, height, weight, BMI, surgical segments, surgical time, blood loss, blood transfusion, ASA score, duration of drainage, total volume of the drainage, variation of WBC and CRP, hospital stay after the removal of the drainage tube and the rate of fever. Student's t-test and the Mann-Whitney U test were used to analyze the continuous data, while the chi-square test was used for the analysis of the ranked data.
Results:
Regarding the comparisons of basic information, there were no significant differences between the two groups for age, height, weight, BMI, surgical segments, surgical time, blood loss, blood transfusion, total drainage volume, duration of drainage, hospital stay, WBC, and CRP variation or the duration of hospital stay after removal of the drainage tube (all p > 0.05). However, the fever rate was significantly different (p = 0.006), and the fever rate of the study group (14/91, 15.38%) was significantly lower than that of the control group (30/92, 32.61%). In the study group, there were no complications related to the use of acetaminophen during the hospital stay or during the outpatient follow-up period.
Conclusion:
Fever after removal of tube drainage is caused by a normal inflammatory response, and a small dose of acetaminophen could significantly reduce the possibility of fever.
... V publikacích zaměřených pouze na neplánované operační revize je zastoupení variabilní od 0,7 % do 29,8 %, v závislosti na zaměření konkrétního souboru pacientů, vlastnostem a kapacitě pracoviště. Ojedinělé multicentrické studie jsou většinou retrospektivní a vycházejí z databází jednotlivých nemocnic na podkladě kódů diagnóz z hospitalizací nebo provedených výkonů (8,16,22,25,27,31). V domácí literatuře jsme nezaznamenali práci zaměřenou na komplikace ve spondylochirurgii. ...
... Ve druhé skupině jsou signifikantní délka operace, krevní ztráta, krevní transfuze, užití instrumentace, rozsah operace, délka pobytu na jednotce pooperační péče a délka pobytu v nemocnici před výkonem (4,6,17,23). Kromě instrumentace ve srovnání s neinstrumentovanými výkony se zdá být zásadní rizikový faktor zadní operační výkon (16,(22)(23)(24)(25). V našem souboru zaujímaly infekční komplikace 1,18 %, to odpovídá podobně zaměřeným pracím (22,23,27,32), z faktorů vázaných na pacienta se v našem souboru potvrzuje věk, kouření a komorbidity. ...
PURPOSE OF THE STUDY Unplanned revision spinal surgeries constitute a complication in the treatment algorithm for the patient, surgeon and the entire treatment team. Any complication leading to an unplanned revision surgery is therefore undesirable. The percentage of complications referred to in publications on this topic focusing on unplanned revision surgeries only varies from 0.7% to 29.8%, with obvious diversity of causes and significant risk factors. The purpose of the submitted paper is to carry out a prospective evaluation of the most serious complications requiring unplanned revision spinal surgeries in the course of 13 years at a single department performing a broad range of spinal surgeries, namely 1300 procedures annually on average. MATERIAL AND METHODS In the period 2006 - 2018, a total of 16872 patients underwent a surgery at our department. During this period, in 556 patients an unplanned revision spinal surgery was performed. In agreement with literature, the patients were categorised by cause for revision: 1/ impaired wound suprafascial (superficial) healing - superficial infection, 2/ impaired wound subfascial (deep) healing - deep infection, 3/ surgical wound hematoma, 4/ deterioration or occurrence of new neurological symptoms, 5/ cerebrospinal fluid leak (liquorrhoea) and 6/ others. The patients operated on for inflammatory diseases of the spine with subsequent infectious complications, primarily treated at another department, and the patients with open spinal injury were excluded from the study. According to these criteria, a cohort of 521 patients was followed up, namely 236 (45.3%) women and 285 (54.7%) men, aged 1 year to 86 years, with the mean age of 55.0 years (median 60 years). Demographic effects, tobacco smoking and comorbidities were followed up in the cohort, together with the effects of surgery, diagnosis, surgical approach and physician. All parameters were statistically evaluated at a p-value below 0.05, including comparison with the control group. RESULTS Of the total number of 16872 operated patients, a group of 521 (3.09%) patients undergoing a revision surgery for complications was analysed in detail. Impaired wound healing - infection (SSI) was found in 199 (1.18%) patients, of whom superficial infection in 124 cases (0.73%) and deep infection in 75 cases (0.44%). Hematoma in a surgical site was detected in 149 (0.88%) patients. In 63 (0.37%) cases, deterioration of the existing neurological finding or occurrence of a new neurological finding were observed, in 68 (0.40%) cases cerebrospinal fluid leak was reported and in 40 (0.24%) cases other complications were identified. As concerns the surgical assistant, the percentage of complications in a board-certified physician is 2.77 (1.14 - 3.29%), in a medical resident it increases to 3.60 (0.00 - 9.38%) (p<0.05). The prevalence of smokers in the group with complications (N=521) was 34.7%. The control group (N=3650) included 30.1% of smokers (p<0.05). The mean age of patients in the group with complications (N=521) was higher, i.e. 55.0 years, with the median age of 60.0 years, than in the primary cohort (N=16872) with the mean age of 49.8 years and the median age of 52.0 years (p<0.05). The mean BMI in the group with complications was (N=521) 27.3, the median BMI was 26.9. In the control group (N=16872), the mean BMI was 27.11, the median BMI was 26.8. In this case the significance (p>0.05) was not confirmed. The complications prevailed strongly in posterior surgical approach, namely in 483 patients (92.7%). As concerns the surgically treated segment, lumber spine dominates with 320 (61.4%) cases. Corticosteroid therapy was used twice as often in women, namely in 13.1% vs. 6.3%. The group of patients with complications (N=521) showed a much higher average length of hospital stay of 12.8 days compared to the average of 4.6 days (N=16872). DISCUSSION In our cohort, the complication rate was 3.09%, of which infections constituted 1.18%, which is in agreement with similarly focused papers. As regards the patient-related factors, in our study the results reported by literature were confirmed with respect to the age, smoking and comorbidities. Moreover, the posterior surgical procedure, lumber spine surgery and presence of a medical resident are essential (p<0.05). No major age difference was observed between women and men (p>0.05). Obesity is one of the key risk factors, especially in infectious complications. In our cohort, a higher BMI did not increase the risk of complications in general (p>0.05). CONCLUSIONS In correlation with current literature, our cohort confirmed a significantly higher risk of complications leading to revision spinal surgery associated with age, smoking, posterior surgical procedure in thoracic or lumber spine, and presence of a medical resident as a surgical assistant. The average length of hospital stay was demonstrably longer in complicated patients, it almost tripled compared to the whole cohort. Contrary to literature, the effect of obesity on the occurrence of complications was not confirmed. Key words: spinal surgery, complications, infection, reoperation, risk factor, hematoma, cerebrospinal fluid leak, screw malposition, smoking, obesity.
... Operative time, the number of levels fused, intraoperative blood loss, and the use of drains are commonly investigated. [33][34][35][36] In this study, these factors were not associated with the development of SSI. Obesity-commonly measured using BMI-is a well-established risk factor for spinal SSI. ...
Background:
Posterior lumbar fusions are a common and successful procedure, yet surgical site infection (SSI) is still prevalent and causes significant morbidity. Obesity is a well-established risk factor for SSI. Still, the accuracy of the body mass index (BMI) caused some to suggest other metrics that are more representative of the thickness of the soft-tissue envelope in the surgical site.
Methods:
A retrospective review of all cases that developed SSI following posterior lumbar fusion over the past 5 years was done. An age and gender-matched control group was formed from the lumbar fusion cases that did not develop SSI. Demographic and clinical data were collected, and morphometric measurements of the soft-tissue envelope were performed at the level of L4 for all cases on standing x-ray imaging and magnetic resonance imaging (MRI).
Results:
A total of 366 patients underwent posterior lumbar fusion, 26 of whom developed SSI. BMI and skin to spinous process measurements on x-ray imaging-not MRI-were found to be significantly associated with SSI. Regression analysis further confirmed the strength of the association.
Conclusion:
While BMI and MRI measurements are useful, wound depth measurements on x-ray imaging can be predictive of SSI in lumbar fusion cases.
Clinical relevace:
Wound depth measurements are predictive of lumbar wound infection. The information within this study can help surgeons better predict and manage infections of posterior lumbar wounds.
Level of evidence: 3:
... As expected, our data similarly demonstrated that sepsis was an independent predictor of sepsis related complications after laminectomy. Interestingly, obesity was not significantly associated with postoperative sepsis in our study, although a growing body of evidence suggests a correlation between obesity and infection risk (40)(41)(42). Although the reasons underpinning this observation were not readily apparent in the NSQIP data, it may be due, at least in part, to the fact that the baseline metabolic profiles of cancer patients are typically vastly altered from those of healthy counterparts. ...
Background:
Posterior laminectomy (LA) for resection of intradural extramedullary tumors (IDEMTs) is associated with postoperative complications, including sepsis. Sepsis is an uncommon but serious complication that can lead to increased morbidity and mortality, prolonged hospital stays, and greater costs. Given the susceptibility of a solid tumor patients to sepsis-related complications, it is important to recognize IDEMT patients as a unique population when assessing the risk factors for sepsis after laminectomy.
Methods:
The study design was a retrospective cohort study. Adult patients undergoing LA for IDEMTs from 2012 to 2018 were identified in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Baseline patient characteristics/comorbidities, operative and hospital variables, and 30-day postoperative complications were collected.
Results:
Of 2,027 total patients undergoing LA for IDEMTs, 38 (2%) had postoperative sepsis. On bivariate analysis sepsis was associated with superficial surgical site infection [odds ratio (OR) 11.62, P<0.001], deep surgical site infection (OR 10.67, P<0.001), deep vein thrombosis (OR 10.75, P<0.001), pulmonary embolism (OR 15.27, P<0.001), transfusion (OR 6.18, P<0.001), length of stay greater than five days (OR 5.41, P<0.001), and return to the operating room within thirty days (OR 8.72, P<0.001). Subsequent multivariate analysis identified the following independent risk factors for sepsis and septic shock: operative time ≥50th percentile (OR 2.11, P=0.032), higher anesthesia class (OR 1.76, P=0.046), dependent functional status (OR 2.23, P=0.001), diabetes (OR 2.31, P=0.037), and chronic obstructive pulmonary disease (OR 3.56, P=0.037).
Conclusions:
These findings can help spine surgeons identify high-risk patients and proactively deploy measures to avoid this potentially devastating complication in individuals who may be more vulnerable than the general elective spine population.
... Amy M. Cizik [10] 2012 USA 63 1532 Retrospective Andrew A. Fanous [11] 2019 USA 20 532 Retrospective CJ. Lucasti [12] 2019 USA 13 74 Retrospective Cindy R. Nahhas [13] 2017 USA 108 2548 Retrospective John J. Lee [14] 2016 USA 15 149 Retrospective Kotaro Satake [15] 2013 USA 11 110 Retrospective Qi Lai [16] 2017 China 26 923 Retrospective Satoshi Ogihara [17] 2015 Japan 24 2736 Retrospective Satoshi Ogihara [18] 2018 Japan 26 4027 Retrospective Satoshi Ogihara [19] 2019 Japan 20 623 Retrospective Sjoerd P. F. T. Nota [20] 2015 USA 361 5761 Retrospective Takashi Sono [21] 2018 Japan 10 637 Retrospective Samer Habiba [22] 2017 Norway 40 1772 Retrospective SHI Lei [23] 2017 China 36 3964 Retrospective Oren G. Blam [24] 2003 USA 24 256 Retrospective Nathan J. Lee [25] 2017 USA 140 5803 Retrospective Muneharu Ando [26] 2014 Japan 8 294 Retrospective Matt El-Kadi [27] 2019 USA 30 5065 Retrospective Jin-Sol Han [28] 2016 Korea 10 280 Retrospective Albert F [29] 2010 USA 46 830 Retrospective Daniël M. C. Janssen [30] 2018 Netherlands 60 898 Retrospective Eiichiro Iwata [31] 2016 Japan 5 85 Retrospective Jin Hak Kim [32] 2015 Korea 30 1831 Retrospective Yusuke Yamamoto [33] 2018 Japan 11 141 Retrospective Can Yaldiz [34] 2015 Turkey 63 540 Retrospective Ankit I. Mehta [35] 2013 Because all studies included were retrospective studies, we used the Newcastle Ottawa Quality Assessment Scale (NOQAS) to assess the quality of each study. This scale for non-randomized case controlled studies and cohort studies were used to allocate a maximum of 9 points for the quality of selection, comparability, exposure, and outcomes for study participants. ...
... Twenty studies [10][11][12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29] reported a history of smoking between SSI group and non-SSI group. There was not significant in the test for heterogeneity and the studies had low heterogeneity (P for heterogeneity = .54; ...
... Selection Comparability Exposure Total score Amy M. Cizik [10] 3 3 2 8 Andrew A. Fanous [11] 3 2 3 8 CJ. Lucasti [12] 2 3 3 8 Cindy R. Nahhas [13] 2 3 2 7 John J. Lee [14] 3 3 2 8 Kotaro Satake [15] 3 2 2 7 Qi Lai [16] 3 3 2 8 Satoshi Ogihara [17] 2 3 3 8 Satoshi Ogihara [18] 3 3 2 8 Satoshi Ogihara [19] 3 2 3 8 Sjoerd P. F. T. Nota [20] 2 2 3 7 Takashi Sono [21] 3 2 3 8 Samer Habiba [22] 2 3 3 8 SHI Lei [23] 2 3 2 7 Oren G. Blam [24] 3 3 2 8 Nathan J. Lee [25] 3 2 2 7 Muneharu Ando [26] 3 3 2 8 Matt El-Kadi [27] 3 3 2 8 Jin-Sol Han [28] 2 3 3 8 Albert F [29] 3 2 2 7 Daniël M. C. Janssen [30] 3 2 3 8 Eiichiro Iwata [31] 2 3 3 8 Jin Hak Kim [32] 2 3 3 8 Yusuke Yamamoto [33] 3 2 2 7 Can Yaldiz [34] 3 3 2 8 Ankit I. Mehta [35] Nineteen studies [10][11][12][13][16][17][18][19][20][24][25][26][28][29][30][31][32][33] reported sex between SSI group and non-SSI group. There was not significant in the test for heterogeneity and the studies had low heterogeneity (P for heterogeneity = 0.16; I 2 = 24%, Fig. 5). ...
Study design:
A meta-analysis.
Background:
We performed a meta-analysis to explore risk factors of surgical site infection (SSI) following spinal surgery.
Methods:
An extensive search of literature was performed in English database of PubMed, Embase, and Cochrane Library and Chinese database of CNKI and WANFANG (up to October 2020). We collected factors including demographic data and surgical factor. Data analysis was conducted with RevMan 5.3 and STATA 12.0.
Results:
Totally, 26 studies were included in the final analysis. In our study, the rate of SSI after spinal surgery was 2.9% (1222 of 41,624). Our data also showed that fusion approach (anterior vs posterior; anterior vs combined), osteotomy, transfusion, a history of diabetes and surgery, hypertension, surgical location (cervical vs thoracic; lumbar vs thoracic), osteoporosis and the number of fusion levels were associated with SSI after spinal surgery. However, age, sex, a history of smoking, body mass index, fusion approach (posterior vs combined), surgical location (cervical vs lumbar), duration of surgery, blood loss, using steroid, dural tear and albumin were not associated with development of SSI.
Conclusions:
In our study, many factors were associated with increased risk of SSI after spinal surgery. We hope this article can provide a reference for spinal surgeons to prevent SSI after spinal surgery.
... The rate of SSI after spinal surgery with implantation has been reported to range from 2.2 to 20%. [1][2][3][4][5][6] Postoperative SSI is divided into three groups according to the onset of infection signs: acute (<2 weeks), subacute (2-4 weeks), and chronic (delayed infection) (>4 weeks), among which the prevalence of delayed infection is the lowest. 7 A delayed infection after spinal implantation may be difficult to diagnose because of its low incidence and variety of clinical manifestations. ...
Introduction
Postoperative surgical site infection remains one of the major complications after spinal surgery. IntraSPINE® (intraspine) is a dynamic intralaminar device introduced by Cousin Biotech and is indicated for the surgical treatment of lumbar spine disorders. There are no reports on delayed surgical site infection (SSI) after lumbar surgery using this device.
Case Presentation
A 29-year-old male patient was admitted to our department with complaints of moderate pain and chronic subcutaneous abscess with purulent flow from his old surgical scar. Thirty-four months ago, he underwent a traditional open bilateral L4 laminotomy without discectomy and intraspine insertion for the treatment of L4-5 central lumbar spinal stenosis at another hospital. The patient was discharged 4 days after surgery without radiating pain, and the surgical wound was well healed. He gradually returned to his normal activity and work. However, he experienced moderate pain, redness and swelling of his old surgical scar approximately one month before coming to our hospital, but he did not receive any treatment. One month later, he had a mass with purulent discharge at the surgical scar site, and he visited our hospital on December 29th, 2020. Based on the physical examination and MRI findings, delayed -SSI was diagnosed. The patient underwent removal of the intraspine device, debridement and wound closure with closed drainage. The wound healed satisfactorily, and the patient had no complaints more than 2 years later.
Conclusion
A delayed surgical site infection following intraspine insertion may have occurred.
