RISK FACTORS FOR POSTOPERATIVE INFECTIONS IN SPINAL FUSION SURGERIES
Main Article Content
Keywords
Spinal fusion, surgical site infection, risk factors, obesity, diabetes mellitus, operative time
Abstract
Introduction: Surgical site infections (SSIs) following spinal fusion surgeries remain a significant challenge in orthopedic practice. This study aimed to identify and evaluate risk factors associated with postoperative infections in patients undergoing spinal fusion surgeries at a tertiary care hospital.
Methods: A prospective cohort study was conducted over 6 months, including 400 patients undergoing spinal fusion surgery. Patient demographics, clinical characteristics, and surgical details were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for SSI.
Results: The overall SSI rate was 6.0% (24/400), with 4.0% superficial and 2.0% deep infections. Obesity (BMI > 30 kg/m²; adjusted OR: 2.41, 95% CI: 1.18-4.93), diabetes mellitus (adjusted OR: 2.13, 95% CI: 1.03-4.41), ASA class ≥ III (adjusted OR: 2.28, 95% CI: 1.09-4.76), operative time > 4 hours (adjusted OR: 2.56, 95% CI: 1.24-5.29), and estimated blood loss > 500 mL (adjusted OR: 2.05, 95% CI: 1.01-4.17) were identified as independent risk factors for SSI.
Conclusion: This study highlights the multifactorial nature of SSI risk in spinal fusion surgery and identifies several key patient-related and surgical factors associated with increased infection rates. Preoperative optimization of modifiable risk factors, improved surgical efficiency, and targeted prevention strategies for high-risk patients may help reduce SSI rates in spinal fusion procedures.
References
2. Ahn, D. K., Lee, S., Choi, D. J., Park, S. Y., Hwang, S. H., Kang, D., & Kim, K. H. (2012). Risk factors for surgical site infection after spine surgery: efficacy of intraoperative saline irrigation. Journal of Korean Neurosurgical Society, 51(2), 74-78.
3. Anderson, D. J., Kaye, K. S., Classen, D., Arias, K. M., Podgorny, K., Burstin, H., ... & Yokoe, D. S. (2008). Strategies to prevent surgical site infections in acute care hospitals. Infection Control & Hospital Epidemiology, 29(S1), S51-S61.
4. Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., ... & Weinstein, R. A. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy, 70(3), 195-283. Epstein, N. E. (2014). A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures. Surgical Neurology International, 5(Suppl 3), S66-S73.
5. Fang, A., Hu, S. S., Endres, N., & Bradford, D. S. (2005). Risk factors for infection after spinal surgery. Spine, 30(12), 1460-1465.
6. Glassman, S. D., Alegre, G., Carreon, L., Dimar, J. R., & Johnson, J. R. (2009). Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus. The Spine Journal, 9(10), 840-845.
7. Kim, D. H., Spencer, M., Davidson, S. M., Li, L., Shaw, J. D., Gulczynski, D., ... & Richmond, J. C. (2010). Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. The Journal of Bone and Joint Surgery, 92(9), 1820-1826.
8. Klein, J. D., Hey, L. A., Yu, C. S., Klein, B. B., Coufal, F. J., Young, E. P., ... & Osborn, L. M. (1996). Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine, 21(22), 2676-2682.
9. Maragakis, L. L., Cosgrove, S. E., Martinez, E. A., Tucker, M. G., Cohen, D. B., & Perl, T. M. (2009). Intraoperative fraction of inspired oxygen is a modifiable risk factor for surgical site infection after spinal surgery. Anesthesiology, 110(3), 556-562.
10. McGirt, M. J., Parker, S. L., Lerner, J., Engelhart, L., Knight, T., & Wang, M. Y. (2011). Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients. Journal of Neurosurgery: Spine, 14(6), 771-778.
11. Mehta, A. I., Babu, R., Karikari, I. O., Grunch, B., Agarwal, V. J., Owens, T. R., ... & Gottfried, O. N. (2012). 2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infections. Spine, 37(19), 1652-1656.
12. Owens, C. D., & Stoessel, K. (2008). Surgical site infections: epidemiology, microbiology and prevention. Journal of Hospital Infection, 70, 3-10.
13. Pull ter Gunne, A. F., & Cohen, D. B. (2009). Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine, 34(13), 1422-1428.
14. Schimmel, J. J., Horsting, P. P., de Kleuver, M., Wonders, G., & van Limbeek, J. (2010). Risk factors for deep surgical site infections after spinal fusion. European Spine Journal, 19(10), 1711-1719.
15. Smith, J. S., Shaffrey, C. I., Sansur, C. A., Berven, S. H., Fu, K. M. G., Broadstone, P. A., ... & Schwab, F. J. (2011). Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine, 36(7), 556-563.
16. Sweet, F. A., Roh, M., & Sliva, C. (2011). Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine, 36(24), 2084-2088.
17. Thomsen, T., Villebro, N., & Møller, A. M. (2010). Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews, (7).
18. Wainwright, T. W., Immins, T., & Middleton, R. G. (2016). Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best Practice & Research Clinical Anaesthesiology, 30(1), 91-102.
19. Weinstein, J. N., Lurie, J. D., Tosteson, T. D., Hanscom, B., Tosteson, A. N., Blood, E. A., ... & Cammisa, F. P. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. Jama, 296(20), 2451-2459.
20. Whitmore, R. G., Stephen, J., Stein, S. C., Campbell, P. G., Yadla, S., Harrop, J. S., ... & Ratliff, J. K. (2012). Patient comorbidities and complications after spinal surgery: a societal-based cost analysis. Spine, 37(12), 1065-1071.
21. Woods, B. I., Rosario, B. L., Chen, A., Waters, J. H., Donaldson, W., Kang, J., & Hilibrand, A. S. (2013). The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery. JBJS, 95(23), 2105-2110.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Gavireddy Naga Srinivasa Rao
Assistant Professor, Department of Orthopedics, Rama Medical College Hospital & Research Centre, Kanpur, Uttar Pradesh