Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-23T05:30:23.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Surgical Site Infections Following Adult Spine Operations

Published online by Cambridge University Press:  30 August 2016

Ambar Haleem ,
Hsiu-Yin Chiang ,
Ravindhar Vodela ,
Andrew Behan ,
Jean M. Pottinger ,
Joseph Smucker ,
Jeremy D. Greenlee ,
Charles Clark  and
Loreen A. Herwaldt
Ambar Haleem
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Hsiu-Yin Chiang
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Ravindhar Vodela
Affiliation:
Mercy Health West Hospital, Cincinnati, Ohio
Andrew Behan
Affiliation:
Mercy Health Lourdes Hospital, Paducah, Kentucky
Jean M. Pottinger
Affiliation:
Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Joseph Smucker
Affiliation:
Indiana Spine Group, Carmel Facility, Carmel, Indiana
Jeremy D. Greenlee
Affiliation:
Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
Charles Clark
Affiliation:
Department of Orthopaedics, University of Iowa Carver College of Medicine, Iowa City, Iowa
Loreen A. Herwaldt*
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
*
Address correspondence to Loreen A. Herwaldt, MD, Department of Internal Medicine, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1081 (loreen-herwaldt@uiowa.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To identify risk factors for surgical site infections (SSIs) after spine operations.

DESIGN

Case-control study of SSIs among patients undergoing spine operations.

SETTING

An academic health center.

PATIENTS

We studied patients undergoing spinal fusions or laminectomies at the University of Iowa Hospitals and Clinics from January 1, 2007, through June 30, 2009. We included patients who acquired SSIs meeting the National Healthcare Safety Network definition. We randomly selected controls among patients who had spine operations during the study period and did not meet the SSI definition.

RESULTS

In total, 54 patients acquired SSIs after 2,309 spine operations (2.3 per 100 procedures). SSIs were identified a median of 20 days after spinal fusions and 17 days after laminectomies; 90.7% were identified after discharge and 72.2% were deep incisional or organ-space infections. Staphylococcus aureus caused 53.7% of SSIs. Of patients with SSIs, 64.9% (fusion) and 70.6% (laminectomy) were readmitted and 59.5% (fusion) and 64.7% (laminectomy) underwent reoperation. By multivariable analysis, increased body mass index, Surgical Department A, fusion of 4–8 vertebrae, and operation at a thoracic or lumbar/sacral level were significant risk factors for SSIs after spinal fusions. Lack of private insurance and hypertension were significant risk factors for SSIs after laminectomies. Surgeons from Department A were more likely to use nafcillin or vancomycin for perioperative prophylaxis and to do more multilevel fusions than surgeons from Department B.

CONCLUSIONS

SSIs after spine operations significantly increase utilization of healthcare resources. Possible remediable risk factors include obesity, hypertension, and perioperative antimicrobial prophylaxis.

Infect Control Hosp Epidemiol 2016;1458–1467

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1458 - 1467
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. We presented part of this study during the 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA) in Dallas, Texas, April 1–4, 2011.

References

REFERENCES

1. McCormack, RA, Hunter, T, Ramos, N, Michels, R, Hutzler, L, Bosco, JA. An analysis of causes of readmission after spine surgery. Spine 2012;37:1260–1266.Google Scholar
2. Abbey, DM, Turner, DM, Warson, JS, Wirt, TC, Scalley, RD. Treatment of postoperative wound infections following spinal fusion with instrumentation. J Spinal Disord 1995;8:278–283.Google Scholar
3. Capen, DA, Calderone, RR, Green, A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am 1996;27:83–86.Google Scholar
4. Browne, JA, Cook, C, Pietrobon, R, Bethel, MA, Richardson, WJ. Diabetes and early postoperative outcomes following lumbar fusion. Spine 2007;32:2214–2219.Google Scholar
5. Mehta, AI, Babu, R, Karikari, IO, et al. 2012 Young Investigator Award winner: the distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine 2012;37:1652–1656.Google Scholar
6. Olsen, MA, Nepple, JJ, Riew, KD, Lenke, LG, Bridwell, KH, Mayfield, J, Fraser, VJ. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surgery Am 2008;90:62–69.CrossRefGoogle ScholarPubMed
7. Patel, N, Bagan, B, Vadera, S, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 2007;6:291–297.CrossRefGoogle ScholarPubMed
8. Pull ter Gunne, AF, Cohen, DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 2009;34:1422–1428.Google Scholar
9. Rao, SB, Vasquez, G, Harrop, J, et al. Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis 2011;53:686–692.Google Scholar
10. Schimmel, JJ, Horsting, PP, de Kleuver, M, Wonders, G, van Limbeek, J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 2010;19:1711–1719.Google Scholar
11. Olsen, MA, Mayfield, J, Lauryssen, C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98:149–155.Google ScholarPubMed
12. Veeravagu, A, Patil, CG, Lad, SP, Boakye, M. Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine 2009;34:1869–1872.CrossRefGoogle ScholarPubMed
13. Wimmer, C, Gluch, H, Franzreb, M, Ogon, M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 1998;11:124–128.CrossRefGoogle ScholarPubMed
14. Meng, F, Cao, J, Meng, X. Risk factors for surgical site infections following spinal surgery. J Clin Neurosci 2015;22:1862–1866.Google Scholar
15. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
16. Fang, A, Hu, SS, Endres, N, Bradford, DS. Risk factors for infection after spinal surgery. Spine 2005;30:1460–1465.Google Scholar
17. Suleiman, LI, Ortega, G, Ong’uti, SK, et al. Does BMI affect perioperative complications following total knee and hip arthroplasty? J Surg Res 2012;174:7–11.Google Scholar
18. Toma, O, Suntrup, P, Stefanescu, A, et al. Pharmacokinetics and tissue penetration of cefoxitin in obesity: implications for risk of surgical site infection. Anesth Analg 2011;113:730–737.CrossRefGoogle ScholarPubMed
19. Wurtz, R, Itokazu, G, Rodvold, K. Antimicrobial dosing in obese patients. Clin Inf Dis 1997;25:112–118.Google Scholar
20. Cheymol, G. Effects of obesity on pharmacokinetics implications for drug therapy. Clin Pharmacokinet 2000;39:215–231.Google Scholar
21. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinal practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195–283.CrossRefGoogle Scholar
22. Olsen, MA, Higham-Kessler, J, Yokoe, DS, et al. Developing a risk stratification model for surgical site infection after abdominal hysterectomy. Infect Control Hosp Epidemiol 2009;30:1077–1083.CrossRefGoogle ScholarPubMed
23. Savage, MW, Pottinger, JM, Chiang, HY, Yohnke, KR, Bowdler, NC, Herwaldt, LA. Surgical site infections and cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 2013;209:108.E1–10.CrossRefGoogle ScholarPubMed
24. Mehio-Sibai, A, Feinleib, M, Sibai, TA, Armenian, HK. A positive or a negative confounding variable? A simple teaching aid for clinicians and students. Ann Epidemiol 2005;15:421–423.Google Scholar
Supplementary material: File

Haleem supplementary material

Supplementary Table

Download Haleem supplementary material(File)
File 18.3 KB