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Zheng T, Wang R, Wu C, Li S, Cao G, Zhang Y, Bu X, Jiang J, Kong Z, Miao Y, Zheng L, Tao G, Tao Q, Ding Z, Wang P, Ren J. Assessing Morinidazole for Surgical Site Infection in Class Ⅲ Wounds Prevention: A Multicenter, Randomized, Single-Blind, Parallel-Controlled Study. J Hosp Infect 2024:S0195-6701(24)00224-X. [PMID: 38964506 DOI: 10.1016/j.jhin.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Surgical site infections are significant postoperative risks, antibiotic prophylaxis is crucial due to the presence of anaerobic bacteria. This study investigated the efficacy and safety of a novel nitroimidazole, morinidazole, in SSI reduction in class Ⅲ wounds, as there is currently a lack of evidence in the existing literature. METHODS A multicenter randomized clinical trial was conducted from December 2020 to October 2022 in the general surgery departments of 12 tertiary hospitals in China. 459 patients in two treatment groups using morinidazole plus ceftriaxone or ceftriaxone alone. Efficacy and safety were evaluated including SSI incidence, adverse events, and compliance. Statistical analysis employed SAS 9.4 software. Data analysis was performed from February to May 2023. RESULTS A total of 440 participants (median [IQR] age, 63.0 [54.0, 70.0] years; 282 males [64.09%]; 437 patients were of Han race [99.32%]) were randomized. The experimental group exhibited a significantly lower SSI rate compared with the control group (31 [14.49%] vs 52 [23.01%]; risk difference, 1.76%, 95%CI, 1.08% to 2.88%; P=0.0224). The superficial incisional site infections revealed a marked reduction in the experimental group (12 [5.61%] vs 31 [13.37%]; risk difference,2.68%; 95%CI,1.34%to5.36%; P=0.0042). Non-surgical site infections, severe postoperative complications, and total adverse events showed no statistically significant differences between the groups (P>0.05). CONCLUSION The significant decrease in SSI rates and superficial incisional infections demonstrates morinidazole as a valuable prophylactic antibiotic. Our findings provided valuable insights for clinical practice, where this new-generation nitroimidazole can play a crucial role in SSI prevention.
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Affiliation(s)
- Tao Zheng
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runnan Wang
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Changliang Wu
- Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shikuan Li
- Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Gaojian Cao
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yong Zhang
- Department of Gastrointestinal Surgery, The People's Hospital of Maanshan, Maanshan, China
| | - Xuefeng Bu
- Department of General Surgery, The First People's Hospital of Zhenjiang, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Jianlong Jiang
- Department of General Surgery, Changshu No. 1 People's Hospital, Affiliated Changshu Hospital of Soochow University, Suzhou, China
| | - Zhiyuan Kong
- Department of General Surgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongchang Miao
- The General Surgery Department of Second People's Hospital of Lianyungang & The General Surgery Department Oncology Hospital of Lianyungang, Lianyungang, China
| | - Lifeng Zheng
- General Surgery Department. Nanjing Jiangbei Hospital, Nanjing, China
| | - Guoqing Tao
- Department of General Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Qingsong Tao
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhongyang Ding
- Department of General Surgery, Wuxi Traditional Chinese Medicine Hospital Affiliated to Nanjing Traditional Chinese Medicine University, Wuxi, China
| | - Peige Wang
- Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Jianan Ren
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China.
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Pang L, Gao Z, Ma L, Li Y, Lu Z, Zhang L, Li P, Wu L. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis. Open Med (Wars) 2024; 19:20240983. [PMID: 38911257 PMCID: PMC11193356 DOI: 10.1515/med-2024-0983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
The bleeding time and amount in the short-segment group were shorter than in the long-segment group, and the bleeding volume was less than in the long-segment group. The Japanese Orthopaedic Association low back pain score, Oswestry Dysfunction Index, and lumbar spine stiffness disability index score of the two groups were significantly improved preoperatively, postoperatively, and at 6 months, 1 year, and 2 years post-operation. The differences were statistically significant at different time points within the groups. Neurological function improved to varying degrees postoperatively. The Cobb angle was significantly higher in both groups (P < 0.05). Adjacent vertebral disease occurred in 10 of 64 patients with short-segment fixation, with a prevalence of 15.6%. Preoperative pelvic tilt angle, preoperative pelvic projection angle (PPA), preoperative degree of matching of PPA to LL (PI-LL), and preoperative coronal Cobb angle were higher in patients with adjacent vertebral disease. There were varying degrees of improvement in low back pain and spinal function after short-segment decompression and fusion internal fixation. However, the patients are generally elderly and at risk of persistent low back pain and accelerated degeneration of adjacent segments.
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Affiliation(s)
- Long Pang
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Zhihui Gao
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Long Ma
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yaping Li
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Zhidong Lu
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Liang Zhang
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Peng Li
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Long Wu
- Third Orthopedic Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
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Oe S, Swamy G, Gagliardi M, Lewis SJ, Kato S, Shaffrey CI, Lenke LG, Matsuyama Y. Wound Closure and Wound Dressings in Adult Spinal Deformity Surgery From the AO Spine Surveillance of Post-Operative Management. Global Spine J 2024:21925682241262749. [PMID: 38869180 DOI: 10.1177/21925682241262749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
STUDY DESIGN An e-mail-based online survey for adult spinal deformity (ASD) surgeons. OBJECTIVE Wound closure and dressing techniques may vary according to the discretion of the surgeon as well as geographical location. However, there are no reports on most common methods. The purpose of this study is to clarify the consensus. METHODS An online survey was distributed via email to AO Spine members. Responses from 164 ASD surgeons were surveyed. The regions were divided into 5 regions: Europe and South Africa (ESA), North America (NA), Asia Pacific (AP), Latin America (LA), and Middle East and North Africa (MENA). Wound closure methods were evaluated by glue(G), staples(S), external non-absorbable sutures (ENS), tapes(T), and only subcuticular absorbable suture (SAS). Wound Dressings consisted of dry dressing (D), plastic occlusive dressing (PO), G, Dermabond Prineo (DP). RESULTS The number of respondents were 57 in ESA, 33 in NA, 36 in AP, 22 in LA, and 16 in MENA. S (36.4%) was the most used wound closure method. This was followed by ENS (26.2%), SAS (14.4%), G (11.8%), and T (11.3%). S use was highest in ESA (44.3%), NA (28.6%), AP (31.7%), and MENA (58.8%). D was used by 50% of surgeons postoperatively. AP were most likely to use PO (36%). 21% of NA used DP, while between 0%-9% of surgeons used it in the rest of the world. CONCLUSION Wound closure and dressings methods differ in the region. There are no current guidelines with these choices. Future studies should seek to standardize these choices.
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Affiliation(s)
- Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ganesh Swamy
- Department of Surgery, Cumming School of Medicine, Calgary, AB, Canada
| | - Martin Gagliardi
- Department of Surgery, Cumming School of Medicine, Calgary, AB, Canada
| | - Stephen J Lewis
- Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Lawrence G Lenke
- Department of Orthopedic Spine Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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Zhang H, Zhao Y, Du Y, Yang Y, Zhang J, Wang S. Early mobilization can reduce the incidence of surgical site infections in patients undergoing spinal fusion surgery: A nested case-control study. Am J Infect Control 2024; 52:644-649. [PMID: 38232902 DOI: 10.1016/j.ajic.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND To examine the influence of early mobilization on the risk of surgical site infections (SSI) in patients undergoing spinal fusion surgery. METHODS The retrospective cohort consisted of all consecutive patients who underwent spinal fusion surgery at our institution. For each case of SSI, 2 control patients without SSI at the corresponding index date were selected. Mobilization was predefined as "delayed" if it occurred more than 36 hours postoperatively. To account for potential confounding variables, we performed further adjustments using conditional logistic regression models. Subgroup analyses were conducted to evaluate the robustness of the statistical associations. RESULTS Following the predefined statistical protocol and matching criteria, we matched 236 control cases to the SSI cases. Upon adjustment for confounding factors, our findings revealed that the risk of SSI was 120% higher in the group beginning mobilization more than 36 hours after surgery compared to the group beginning mobilization within 36 hours postoperatively (odds ratio = 2.206, 95% confidence interval 1.169-4.166, P = .015). In subgroup analyses, this statistical trend remained consistent. CONCLUSIONS Early mobilization within 36 hours following spinal fusion surgery significantly reduces the risk of SSI. This pattern of reduced risk remains consistent among patients with degenerative diseases or spinal deformities.
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Affiliation(s)
- Haoran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Rajkovic CJ, Tracz JA, DeMordaunt T, Davidar AD, Perdomo-Pantoja A, Judy BF, Zhang KY, Hernandez VN, Lin J, Lazzari JL, Cottrill E, Witham TF. Synthesis and evaluation of a novel vancomycin-infused, biomimetic bone graft using a rat model of spinal implant-associated infection. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100323. [PMID: 38746017 PMCID: PMC11091687 DOI: 10.1016/j.xnsj.2024.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 05/16/2024]
Abstract
Background Postoperative infection is a complication of spinal fusion surgery resulting in increased patient morbidity. Strategies including intraoperative application of powdered vancomycin have been proposed to reduce the incidence of infection; however, such antimicrobial effects are short-lived. Methods Instrumentation of the L4-L5 vertebrae was performed mimicking pedicle screw and rod fixation in 30 rats. Titanium instrumentation inoculated with either PBS or 1×105 CFU bioluminescent MRSA, along with biomimetic bone grafts infused with varying concentrations of vancomycin and 125 µg of rhBMP-2 (BioMim-rhBMP-2-VCM) were implanted prior to closure. Infection was quantified during the six-week postoperative period using bioluminescent imaging. Arthrodesis was evaluated using micro-CT. Results Infected animals receiving a bone graft infused with low-dose (0.18 mg/g) or high-dose vancomycin (0.89 mg/g) both exhibited significantly lower bioluminescent signal over the six-week postoperative period than control animals inoculated with MRSA and implanted with bone grafts lacking vancomycin (p=.019 and p=.007, respectively). Both low and high-dose vancomycin-infused grafts also resulted in a statistically significant reduction in average bioluminescence when compared to control animals (p=.027 and p=.047, respectively), independent of time. MicroCT analysis of animals from each group revealed pseudoarthrosis only in the control group, suggesting a correlation between infection and pseudoarthrosis. MRSA-inoculated control animals also had significantly less bone volume formation on micro-CT than the PBS-inoculated control cohort (p<.001), the MRSA+low-dose vancomycin-infused bone graft cohort (p<.001), and the MRSA+high-dose vancomycin-infused bone graft cohort (p<.001). Conclusion BioMim-rhBMP-2-VCM presents a novel tissue engineering approach to simultaneously promoting arthrodesis and antimicrobial prophylaxis in spinal fusion. Despite mixed evidence of potential osteotoxicity of vancomycin reported in literature, BioMim-rhBMP-2-VCM preserved arthrodesis and osteogenesis with increasing vancomycin loading doses due to the graft's osteoinductive composition.
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Affiliation(s)
- Christian J Rajkovic
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Jovanna A Tracz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Trevor DeMordaunt
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Alexander Perdomo-Pantoja
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue Campus Box 8057, St. Louis, MO 63110, United States
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Kevin Yang Zhang
- Department of Pathology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Vaughn N Hernandez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Jessica Lin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Julianna L Lazzari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 104002, Durham, NC 27710, United States
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
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Sun JY, Zhao N, Chen H, Chen CH. Thoracolumbar fractures patients undergoing posterior pedicle screw fixation can benefit from drainage. BMC Musculoskelet Disord 2024; 25:343. [PMID: 38693479 PMCID: PMC11061928 DOI: 10.1186/s12891-024-07447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To explore whether it is necessary to put drain tubes after posterior pedicle screw fixation of thoracolumbar fractures. METHODS From April 2020 to January 2023, a total of 291 patients with recent thoracolumbar fractures (AO type-A or type-B) who received the pedicle screw fixation operation were enrolled retrospectively. In 77 patients, drain tubes were used in the pedicle screw fixation surgery, while no drain tubes were placed in the other group. After gleaning demographic information and results of lab examination and imageology examination, all data were put into a database. Independent-sample t-tests, Pearson Chi-Square tests, Linear regression analysis, and correlation analysis were then performed. RESULTS Compared to the control group, the drainage group had significantly lower postoperative CRP levels (P = 0.047), less use of antipyretics (P = 0.035), higher ADL scores (P = 0.001), and lower NRS scores (P < 0.001) on the 6th day after surgery. Other investigation items, such as demographic information, operation time, intraoperative blood loss, body temperature, and other preoperative and postoperative lab results, showed no significant differences. CONCLUSIONS The use of a drain tube in the pedicle screw fixation of thoracolumbar fractures is correlated with the improvement of patients' living and activity ability and the reduction of inflammation, postoperative fever and pain.
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Affiliation(s)
- Jing-Yu Sun
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road , Wenzhou, Zhejiang, 325000, China
| | - Ning Zhao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road , Wenzhou, Zhejiang, 325000, China
| | - Hua Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road , Wenzhou, Zhejiang, 325000, China
| | - Chun-Hui Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road , Wenzhou, Zhejiang, 325000, China.
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Kristensen MKS, Filtenborg JT, Miscov R, Gulisano HA, Bjarkam CR. Use of an Antibacterial Envelope in Spinal Cord Stimulation Reduces the Rate and Severity of Iatrogenic Infections. World Neurosurg 2024; 185:e820-e826. [PMID: 38432508 DOI: 10.1016/j.wneu.2024.02.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To examine if the use of an antibacterial envelope (TYRX) decreases the rate of postoperative infection in chronic pain patients undergoing treatment with spinal cord stimulation (SCS) involving device implantation. METHODS Single-center retrospective cohort study comparing postoperative infections rates in non-TYRX recipients from 2018 to 2020 with recipients of a TYRX antibacterial envelope from 2020 to 2021. Infection was registered if a patient received any form of antibiotic treatment after hospital discharge within a follow-up period of 100 days. RESULTS A total of 198 patients were included: 100 in the TYRX group and 98 in the non-TYRX group. There were no significant differences between the 2 groups regarding age, body mass index (BMI), smoking, diabetes, and use of immunosuppression. The overall infection rate was 5.6%. The infection rate was 4% in the TYRX group and 7.1% in the non-TYRX group (P = 0.6). However, the 4 cases of postoperative infection in the TYRX group could be effectively managed with oral antibiotics alone, whereas 6 out of the 7 patients in the non-TYRX group required intravenous antibiotics. Moreover, device explantation was necessary in 3 of these patients suggesting the event of more severe infections in the non-TYRX group (P = 0.014). CONCLUSIONS The TYRX antibacterial envelope displayed infection rates reducing capabilities, along with a clear tendency to reduce revision surgeries and system removals due to infections.
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Affiliation(s)
| | | | - Rares Miscov
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
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González-Kusjanovic N, Delgado Ochoa B, Vidal C, Campos M. Post-operative complications affect survival in surgically treated metastatic spinal cord compression. INTERNATIONAL ORTHOPAEDICS 2024; 48:1341-1350. [PMID: 38472466 DOI: 10.1007/s00264-024-06120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients. METHODS Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups. RESULTS Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence. CONCLUSION In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.
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Affiliation(s)
- Nicolás González-Kusjanovic
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Byron Delgado Ochoa
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Catalina Vidal
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Mauricio Campos
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile.
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Ali NS, Fitzpatrick Iv TH, Islam AS, Nord RS. Mitigating Infection Risk in Upper Airway Stimulation. Ann Otol Rhinol Laryngol 2024; 133:277-283. [PMID: 37927122 DOI: 10.1177/00034894231209540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This study aims to define the incidence of infection with upper airway stimulation (UAS) devices requiring explantation in a single academic center and identify factors that may influence the risk of infection. METHODS A database of patients who underwent UAS at a single tertiary referral academic center from 2017 to 2021 was retrospectively reviewed to identify patients who developed surgical site infections, with and without subsequent explantation. Additional data for cases complicated by infection was extracted from the electronic medical record (EMR) and included: demographic information, medical history, complications and management, and overall outcomes. In March 2021, 2 modifications to infection control protocols were implemented: double skin preparation with Betadine and chlorhexidine, and MRSA decolonization. Statistical analysis was performed to compare infectious risk before and after these protocol changes. RESULTS In the study period, 215 patients underwent UAS in the specified time period and 3 cases (1.4%) of postoperative infections were identified, all of which required explantation. The infection rate did not significantly change after modifications to the surgical prep protocol (P = .52). CONCLUSIONS While no significant difference in infection risk was noted after modifying infection control protocols, additional longer-term study is warranted to elucidate effective infection reduction strategies.
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Affiliation(s)
- Naushin S Ali
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas H Fitzpatrick Iv
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Albina S Islam
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Ryan S Nord
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Ambrosio L, Vadalà G, Tavakoli J, Scaramuzzo L, Brodano GB, Lewis SJ, Kato S, Cho SK, Yoon ST, Kim HJ, Gary MF, Denaro V. Surgeon Preference Regarding Wound Dressing Management in Lumbar Fusion Surgery: An AO Spine Global Cross-Sectional Study. Neurospine 2024; 21:204-211. [PMID: 38569644 PMCID: PMC10992664 DOI: 10.14245/ns.2347168.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions. METHODS A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons' preferences were analyzed. RESULTS Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001). CONCLUSION Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.
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Affiliation(s)
- Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Javad Tavakoli
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Laura Scaramuzzo
- Spine Surgery Division 1, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | | | - Stephen J Lewis
- UHN-Orthopedics, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Matthew F Gary
- Departments of Neurosurgery and Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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11
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Meng S, Meng M, Wang S, Zheng W. Analysis of surgical site infection and tumour-specific survival rate in patients with renal cell carcinoma after laparoscopic radical nephrectomy. Int Wound J 2024; 21:e14711. [PMID: 38387886 PMCID: PMC10834101 DOI: 10.1111/iwj.14711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
Surgical site infections (SSIs) may pose a significant risk to patients undergoing surgery. This study aims to explore the risk factors for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma and the impact of infection on tumour-specific survival (CSS) after nephrectomy for renal cell carcinoma. To explore the risk factors for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma and the impact of infection on tumour-specific survival (CSS) after nephrectomy for renal cell carcinoma. A retrospective analysis was conducted on 400 patients in our hospital from June 2021 to June 2023. This study divided patients into two groups: those with SSI and those without SSI. Collect general data and information related to the operating room. Clearly defined inclusion and exclusion criteria. Select surgical time, laminar mobile operating room use, and intraoperative hypothermia as observation indicators. Perform statistical analysis using SPSS 25.0 software, including univariate, multivariate, and survival analyses of wound-infected and uninfected patients. Out of 400 patients, 328 had no SSIs, 166 died during follow-up, 72 had SSIs, and 30 died during follow-up. There was no statistically significant difference (p > 0.05) in comparing primary data between individuals without SSIs and those with SSIs. There were statistically significant differences (p < 0.05) in surgical time, nonlaminar flow operating room use, and intraoperative hypothermia. The postoperative survival time of SSI patients with a tumour diameter of 7.0-9.9 cm was significantly longer than that of SSI patients, and the difference was statistically significant (p < 0.05). The occurrence of severe infection in patients with other tumour diameters did not affect postoperative survival, and the difference was not statistically significant (p > 0.05). After multiple factor analysis, it was found that severe infection can prolong the postoperative survival of patients with tumour diameter exceeding 7 cm (HR = 0.749, p < 0.05). This study identified nonlaminar flow operating rooms, prolonged surgical time, and intraoperative hypothermia as significant risk factors for SSIs. After nephrectomy for renal cell carcinoma patients with a tumour diameter of 7-9.9 μ m, perioperative infection can prolong their survival. However, it has no significant effect on patients with other tumour diameters.
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Affiliation(s)
- Shuai Meng
- Department of UrologyFirst Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouChina
| | - Meng Meng
- Department of PharmacyJinan Zhangqiu District Hospital of TCMJinanChina
| | - Shouwu Wang
- Department of PharmacyJinan Zhangqiu District Hospital of TCMJinanChina
| | - Wei Zheng
- Urology & Nephrology Center, Department of UrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
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12
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Shen J, Xie X, Meng Y, Mu Y. Predictive value of preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio combined with operating room factors for surgical site infection after laparoscopic radical nephrectomy in renal cell carcinoma patients. Int Wound J 2024; 21:e14400. [PMID: 37718121 PMCID: PMC10788578 DOI: 10.1111/iwj.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) can pose significant risks to patients undergoing surgical procedures. This study aimed to investigate the risk factors and diagnostic value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) for SSIs in patients undergoing laparoscopic radical nephrectomy for renal cell carcinoma. METHODS A retrospective analysis of 866 patients at our hospital was conducted between June 2016 and June 2022. The study divided patients into two groups: those with SSIs and those without. General data and operative room-related information were collected. Inclusion and exclusion criteria were clearly defined. Peripheral blood indicators were analysed, and observation indicators were meticulously selected, including surgery time, usage of a laminar flow operating room and intraoperative hypothermia. Statistical analysis was performed using SPSS 25.0 software, including univariate, multivariate analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Thirty-six out of 866 patients developed SSIs. Statistically significant differences were found for surgery time, usage of non-laminar flow operating rooms and intraoperative hypothermia (p < 0.05). ROC curve analysis showed an AUC of 0.765 (95% CI: 0.636-0.868) for serum NLR and PLR, with optimal cut-off values at NLR 4.8 and PLR 196, indicating moderate to strong discriminative ability for SSIs. CONCLUSIONS The study identified non-laminar flow operating rooms, extended surgery time, and intraoperative hypothermia as significant risk factors for SSIs. Serum NLR and PLR were found valuable as biomarkers for SSIs diagnosis, holding potential for preoperative risk assessment and improved patient safety in renal cell carcinoma care.
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Affiliation(s)
- Jun Shen
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Xun Xie
- Department of NephrologyThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Yonghui Meng
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Youyou Mu
- Department of Urology SurgeryThe Frist Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
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13
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Anwar FN, Roca AM, Khosla I, Medakkar SS, Loya AC, Federico VP, Massel DH, Sayari AJ, Lopez GD, Singh K. Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100278. [PMID: 37965567 PMCID: PMC10641566 DOI: 10.1016/j.xnsj.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 11/16/2023]
Abstract
Background A growing emphasis on antibiotic stewardship has led to extensive literature regarding antibiotic use in spine surgery for surgical prophylaxis and the treatment of spinal infections. Purpose This article aims to review principles of antibiotic stewardship, evidence-based guidelines for surgical prophylaxis and ways to optimize antibiotics use in the treatment of spinal infections. Methods A narrative review of several society guidelines and spine surgery literature was conducted. Results Antibiotic stewardship in spine surgery requires multidisciplinary investment and consistent evaluation of antibiotic use for drug selection, dose, duration, drug-route, and de-escalation. Developing effective surgical prophylaxis regimens is a key strategy in reducing the burden of antibiotic resistance. For treatment of primary spinal infection, the diagnostic work-up is vital in tailoring effective antibiotic therapy. The future of antibiotics in spine surgery will be highly influenced by improving surgical technique and evidence regarding the role of bacteria in the pathogenesis of degenerative spinal pathology. Conclusions Incorporating evidence-based guidelines into regular practice will serve to limit the development of resistance while preventing morbidity from spinal infection. Further research should be conducted to provide more evidence for surgical site infection prevention and treatment of spinal infections.
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Affiliation(s)
- Fatima N. Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Andrea M. Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Srinath S. Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Alexandra C. Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Dustin H. Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Arash J. Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Gregory D. Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
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14
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Stoehr JR, Le NK, Urban D, Koussayer B, Kuykendall L, Hayman E, Troy JS. Reducing drain use with paraspinal muscle flaps for spinal closures: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2023; 87:83-90. [PMID: 37826967 DOI: 10.1016/j.bjps.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Paraspinal muscle (PSM) flaps can be mobilized with superficial undermining and lateral release from the thoracolumbar fascia and/or deep undermining and medial release from the transverse processes and ribs. The objective of the study was to compare the effect of the PSM flap technique on drain use, retention, and complication rates. METHODS A retrospective chart review was performed for patients who underwent spinal coverage with PSM flaps at a single institution from April 2020 to June 2021. Patient demographics, preoperative comorbidities, surgical technique, drain usage, and postoperative complications were analyzed to compare the effects of different PSM flap surgical techniques on postoperative drain use and complications. RESULTS Sixty patients were included. Both superficial and deep releases were performed in half (47%) of the cases, while the remainder was split between superficial (25%) and deep (28%) releases. Drains were used less frequently for the deep release (35%) than the superficial (93%) or both releases (96%, p < 0.01). The deep release had shorter mean drain retention time (5.8 days) than the superficial (30.3 days) or both releases (24.8 days, p < 0.01). There were no significant differences between the techniques in terms of complications. For the deep release, the use of drains was not associated with a reduction in complications (odds ratio 0.91 [0.84 - 0.98], p = 0.97). CONCLUSIONS In a selected patient population, a "deep release only" PSM flap technique may allow for drainless spinal closure without an increased risk of seroma or other complications.
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Affiliation(s)
- Jenna R Stoehr
- Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Nicole K Le
- Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - DaKota Urban
- Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Bilal Koussayer
- Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Lauren Kuykendall
- Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Erik Hayman
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Jared S Troy
- Department of Plastic Surgery, University of South Florida, Tampa, FL, USA.
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15
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Day W, Ch'en PY, Ratnasamy PP, Jeong S, Varthi AG, Grauer JN. The correlation of psoriasis and its treatment medications with lumbar discectomy postoperative infections. Spine J 2023; 23:1623-1629. [PMID: 37355045 DOI: 10.1016/j.spinee.2023.06.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND CONTEXT Psoriasis is a chronic, autoimmune disease of the skin that affects approximately 3% of the US adult population. Patients with psoriasis may be predisposed to spine surgical site infections (SSI) related to the condition and/or related medications following surgeries such as lumbar laminotomy/discectomy. PURPOSE To assess the potential correlation of psoriasis and its related treatment medications on the risk of infection-related complications after lumbar laminotomy/discectomy. STUDY DESIGN Retrospective case control, national administrative database study. PATIENT SAMPLE Adult patients who underwent isolated single-level lumbar discectomy between 2010 and Q1 of 2021 were identified in the PearlDiver Mariner Ortho151 national administrative database (excluding those with concurrent diagnoses of fractures, neoplasms, or infections). OUTCOME MEASURES Ninety-day postoperative rates of surgical site infection and sepsis. METHODS Lumbar laminotomy/discectomy patients with versus without psoriasis were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index. The risk of SSI and sepsis in the 90-day postoperative window between the cohorts were compared with multivariable analyses. Five-year reoperation rates were also compared with log rank test. The matched psoriasis cohort was further subdivided by psoriasis treatment regimens - no medication treatment (NT), topical therapies only (TT), topical therapies with oral systemic treatments (TT/OS), and topical therapies with biologics (TT/B). Multivariable logistic regression was used to assess the risk of SSI and sepsis within 90 days after lumbar laminotomy/discectomy for each treatment subgroup compared to patients without psoriasis. RESULTS In total, 2,262 patients with psoriasis who underwent single-level lumbar laminotomy/discectomy were identified and matched by age, sex, and Elixhauser Comorbidity Index to 9,044 patients without psoriasis. Multivariable logistic regression showed that, compared to the patients without psoriasis, patients with psoriasis had a 1.795 times higher chance of developing SSI (odds ratio [OR]) (p<.001) and sepsis (OR: 1.743, p=.027) within 90 days of surgery. Having psoriasis did not significantly correlate with 5-year reoperation rates. Of those with psoriasis, NT subcohort had 1,038 patients, TT subcohort 571 patients, TT/OS subcohort 226 patients, and TT/B subcohort 140 patients. Based on multivariable analysis and compared to nonpsoriasis patients, those in the NT, TT, TT/OS were not at greater odds of postoperative SSI or sepsis. Conversely, those in the TT/B subcohort were at significantly greater odds of SSI (OR: 3.102, p=.019) and sepsis (OR: 6.367, p=.027). CONCLUSIONS Of single-level lumbar laminotomy/discectomy patients with psoriasis, only those on topical therapies and biologics were at greater risk of postoperative SSI and sepsis. This subcohort warrants specific attention when undergoing lumbar laminotomy/discectomy and possibly holding such medications for a period prior to surgery may be warranted if possible.
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Affiliation(s)
- Wesley Day
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Peter Y Ch'en
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Philip P Ratnasamy
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA
| | - Seongho Jeong
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA
| | - Arya G Varthi
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA.
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16
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Cabrera JP, Gary MF, Muthu S, Yoon ST, Kim HJ, Cho SK, Ćorluka S, Lewis SJ, Kato S, Buser Z, Wang JC, Hsieh PC. Surgeon Preferences Worldwide in Wound Drain Utilization in Open Lumbar Fusion Surgery for Degenerative Pathologies. Global Spine J 2023:21925682231210184. [PMID: 37897691 DOI: 10.1177/21925682231210184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE Although literature does not recommend routine wound drain utilization, there is a disconnect between the evidence and clinical practice. This study aims to explore into this controversy and analyze the surgeon preferences related to drain utilization, and the factors influencing drain use and criterion for removal. METHODS A survey was distributed to AO Spine members worldwide. Surgeon demographics and factors related to peri-operative drain use in 1 or 2-level open fusion surgery for lumbar degenerative pathologies were collected. Multivariate analyses by drain utilization, and criterion of removal were conducted. RESULTS 231 surgeons participated, including 220 males (95.2%), orthopedics (178, 77.1%), and academic/university-affiliated (114, 49.4%). Most surgeons preferred drain use (186, 80.5%) and subfascial drains (169, 73.2%). Drains were removed based on duration by 52.87% of the surgeons, but 27.7% removed drains based on outputs. On multivariable analysis, significant predictors of drain use were surgeon's aged 35-44 (OR = 11.9, 95% CI = 1.2-117.2, P = .034), 45-54 (29.1, 3.1-269.6, P = .003), 55-64 (8.9, 1.4-56.5, .019), and wound closure using coaptive films (6.0, 1.2-29.0, P = .025). Additionally, surgeons from Asia Pacific (OR = 5.19, 95% CI = 1.65-16.38, P = .005), Europe (3.55, 1.22-10.31, P = .020), and Latin America (4.40, 1.09-17.83, .038) were more likely to remove drain based on time duration, but surgeons <5 years of experience (10.23, 1.75-59.71, P = .010) were more likely to remove drains based on outputs. CONCLUSIONS Most spine surgeons worldwide prefer to place a subfascial wound drain for degenerative open lumbar surgery. The choice for drain placement is associated with the surgeon's age and use of coaptive films for wound closure, while the criterion for drain removal is associated with the surgeons' region of practice and experience.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Matthew F Gary
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, India
- Department of Orthopaedics, Government Medical College, Karur, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India
| | - S Tim Yoon
- Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of South Korea
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stipe Ćorluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Stephen J Lewis
- Department of Orthopaedics, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick C Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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17
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Zheng G, Shi Y, Sun J, Wang S, Li X, Lv H, Zhang G. Effect of antibiotic prophylaxis in the prognosis of Post-neurosurgical meningitis patients. Eur J Med Res 2023; 28:396. [PMID: 37794524 PMCID: PMC10548647 DOI: 10.1186/s40001-023-01399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
AIMS To evaluate the effect of antibiotic prophylaxis(AP) in the prognosis of Post-neurosurgical meningitis(PNM) patients. METHODS A cohort analysis was performed using the clinical database in Beijing Tiantan Hospital and Capital Medical University. Data were collected on patients with the diagnosis of PNM (n = 3931) during 2012.01 to 2022.04. The microbial distribution, types of AP, and 42 and 90 days survival analysis of AP patients were evaluated using probable statistical methods. Independent risk factors for mortality were established by constructing a logistic regression analysis. RESULT A total of 1,190 patients were included in this study, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus occupied the highest proportion. Of them, 929 cases received AP, cefuroxime and ceftriaxone are the most frequent used antibiotics. In addition, We found that PNM patients without AP significantly increased the 42 days and 90 days all-cause mortality rates. The use of different levels of AP did not improve patient outcomes, and ICU admission and assisted mechanical ventilation (AMV) were identified as independent mortality risk factors for PNM patient received AP. CONCLUSIONS AP plays an important role in the prognosis of PNM patients and has a significant function in improving prognosis. The prevention of PNM with antibiotics prior to neurosurgery should be emphasized in clinical practice, and appropriate selection of antibiotics is necessary to prevent the occurrence of infection and inhibit the emergence of antibiotic-resistant bacteria.
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Affiliation(s)
- Guanghui Zheng
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China
| | - Yijun Shi
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China
| | - Jialu Sun
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
| | - Siqi Wang
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
| | - Xiang Li
- Clinical Diagnosis College of Capital Medical University, Beijing, 100076, China
| | - Hong Lv
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China
| | - Guojun Zhang
- Clinical Diagnosis Laboratory of Beijing Tiantan Hospital, Capital Medical University, NO. 119 Nansihuan West Road, Fengtai District, Beijing, 100076, China.
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, 100076, China.
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, 100076, China.
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18
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Choi SR, Kwon JW, Suk KS, Kim HS, Moon SH, Park SY, Moon SE, Lee BH. Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study. Bioengineering (Basel) 2023; 10:1143. [PMID: 37892873 PMCID: PMC10604172 DOI: 10.3390/bioengineering10101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
This retrospective study was designed to investigate the effectiveness of using a toothbrush, which is commonly used in our daily life, for biofilm removal and infection control in the treatment of spinal infections occurring after spinal fusion surgery. Currently, a biofilm is thought to form on the surface of the metal inserted during spine fusion surgery. We aim to determine the differences in clinical outcomes between using and not using a toothbrush to remove biofilm while performing conventional drainage, curettage, and debridement. A total of 1081 patients who underwent anterior or posterior spinal fusion surgery between November 2018 and October 2022 were screened. The study included 60 patients who developed surgical site infection and underwent incision and drainage surgery either with a toothbrush (n = 20) or without a toothbrush (n = 40). Failure of infection control that requires revision surgery occurred in 2 patients (10%) in the Toothbrush group and in 14 patients (35%) in the No-Toothbrush group (p = 0.039). Thus, the rate of additional surgery was significantly lower in the Toothbrush group. Additionally, normalization of c-reactive protein levels occurred significantly faster in the Toothbrush group (p = 0.044). Therefore, using a toothbrush to treat spinal infections following spinal fusion surgery appears to have beneficial mechanical debridement effects, resulting in improved clinical results, which were also confirmed based on the electron microscopic images.
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Affiliation(s)
- Sung-Ryul Choi
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Si-Young Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seung-Eon Moon
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Byung-Ho Lee
- Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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19
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Rocos B, Kato S, Lewis SJ, Shaffrey CI, Lenke LG. Antibiotic Use in Adult Spine Deformity Surgery: Results From the AO Spine Surveillance of the Management of Patients With Adult Spine Deformity. Global Spine J 2023:21925682231201240. [PMID: 37683295 DOI: 10.1177/21925682231201240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
STUDY DESIGN Cross-sectional international survey with literature review. OBJECTIVES To evaluate the evidence for these strategies and to understand the current trends in prophylactic antibiotic use during ASD surgery through an international survey. METHODS An online survey was conducted among international AO Spine members regarding the peri-operative management of patients with ASD. The details of perioperative systemic and topical antibiotic use were solicited. Descriptive data were summarized for the responding surgeons who perform at least 10 long-segment fusions of >5 levels extending to the pelvis annually. RESULTS The literature supports the use of prophylactic antibiotic effective against gram positive organisms. The use of topical vancomycin remains debated, and there is limited evidence for topical tobramycin use. A total of 116 responses were received. 74 (64%) surgeons use topical vancomycin, most usually deep to the fascia only 45 (61%). The most usual dose used is 1-2 g. 4 (3%) surgeons use topical tobramycin deep to fascia. Following surgery, 90 (78%) surgeons use prophylactic cephalosporin with 3 (3%) using cloxacillin, 5 (4%) using ciprofloxacin and 9 (8%) using vancomycin and 6 (5%) using clindamycin either in addition or alone. CONCLUSIONS The present survey identifies a trend towards systemic and topical antibiotic prophylaxis primarily targeted at gram positive pathogens. The use of topical tobramycin, proposedly effective against gram negative infections, remains uncommon. There is a lack of consensus in the selection of perioperative antibiotic prophylaxis, thus a prospective study of the rates of infection with each strategy would be useful to inform guidelines.
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Affiliation(s)
- Brett Rocos
- Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- AO Knowledge Forum Deformity, Davos, Switzerland
| | - So Kato
- AO Knowledge Forum Deformity, Davos, Switzerland
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Stephen J Lewis
- AO Knowledge Forum Deformity, Davos, Switzerland
- Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher I Shaffrey
- Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- AO Knowledge Forum Deformity, Davos, Switzerland
| | - Lawrence G Lenke
- AO Knowledge Forum Deformity, Davos, Switzerland
- Department of Orthopedic Spine Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA
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Rocos B, Davidson B, Rabinovitch L, Rampersaud YR, Nielsen C, Jiang F, Vaisman A, Lewis SJ. Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusions. Spine Deform 2023; 11:1209-1221. [PMID: 37147477 DOI: 10.1007/s43390-023-00694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/15/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Postoperative surgical site infection in patients treated with lumbosacral fusion has usually been thought to be caused by perioperative contamination. With the proximity of these incisions to the perineum, this study sought to determine if contamination by gastrointestinal and/or urogenital flora should be considered as a major cause of this complication. METHODS We conducted a retrospective review of adults treated with open posterior lumbosacral fusions between 2014 and 2021 to identify common factors in deep postoperative infection and the nature of the infecting organisms. Cases of tumor, primary infection and minimally invasive surgery were excluded. RESULTS 489 eligible patients were identified, 20 of which required debridement deep to the fascia (4.1%). Mean age, operative time, estimated blood loss and levels fused were similar between both groups. The infected group had a significantly higher BMI. The mean time from primary procedure to debridement was 40.8 days. Four patients showed no growth, 3 showed Staphylococcus sp. infection (Perioperative Inside-Out) requiring debridement at 63.5 days. Thirteen showed infection with intestinal or urogenital pathogens (Postoperative Outside-In) requiring debridement at 20.0 days. Postoperative Outside-In infections led to debridement 80.3 days earlier than Perioperative Inside-Out infections (p = 0.007). CONCLUSIONS 65% of deep infections in patients undergoing open lumbosacral fusion were due to early contamination by pathogens associated with the gastrointestinal and/or urogenital tracts. These required earlier debridement than Staphylococcus sp. INFECTIONS There should be renewed focus on keeping these pathogens away from the incision during the early stages of wound healing.
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Affiliation(s)
- Brett Rocos
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada
| | - Bela Davidson
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada
| | - Lily Rabinovitch
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada
| | - Christopher Nielsen
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada
| | - Fan Jiang
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada
| | - Alon Vaisman
- Infection Prevention and Control, University Health Network, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Stephen J Lewis
- Schroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst Street, 442, 1 East Wing, Toronto, ON, M5T 2S8, Canada.
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Niu Y, Liu J, Qin H, Liu Y, Huang N, Jiang J, Chen Y, Chen S, Bai T, Yang C, Cao Y, Liu S, Yuan H. Development of an innovative minimally invasive primate spinal cord injury model: A case report. IBRAIN 2023; 9:349-356. [PMID: 37786753 PMCID: PMC10527794 DOI: 10.1002/ibra.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 10/04/2023]
Abstract
Spinal cord injury (SCI) animal models have been widely created and utilized for repair therapy research, but more suitable experimental animals and accurate modeling methodologies are required to achieve the desired results. In this experiment, we constructed an innovative dorsal 1/4 spinal cord transection macaque model that had fewer severe problems, facilitating postoperative care and recovery. In essence, given that monkeys and humans share similar genetics and physiology, the efficacy of this strategy in a nonhuman primate SCI model basically serves as a good basis for its prospective therapeutic use in human SCI.
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Affiliation(s)
- Yong‐Min Niu
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Jin‐Xiang Liu
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Hao‐Yue Qin
- Department of AnesthesiologySouthwest Medical UniversityLuzhouSichuanChina
| | - Yi‐Fan Liu
- Yunnan Cancer HospitalThe Third Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Ni‐Jiao Huang
- Department of Orthopaedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Ji‐Li Jiang
- Institute of NeuroscienceKunming Medical UniversityKunmingYunnanChina
| | - Yan‐Qiu Chen
- School of Preclinical MedicalZunyi Medical UniversityZunyiGuizhouChina
| | - Si‐Jing Chen
- Nursing SchoolZunyi Medical UniversityZunyiGuizhouChina
| | - Tao Bai
- School of Preclinical MedicalKunming Medical UniversityKunmingYunnanChina
| | - Chang‐Wei Yang
- Department of Nuclear MedicineAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yu Cao
- Department of Nuclear MedicineAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Sheng Liu
- Pharmacology InstituteHeidelberg UniversityHeidelbergGermany
| | - Hao Yuan
- Department of Orthopaedic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Molina M, Torres R, Castro M, Gonzáles L, Weissmann K, Martinez M, Ganga M, Postigo R. Wound drain in lumbar arthrodesis for degenerative disease: an experimental, multicenter, randomized controlled trial. Spine J 2023; 23:473-483. [PMID: 36509378 DOI: 10.1016/j.spinee.2022.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Drains for surgical wound management are frequently used in spine surgery. They are often used to decrease the incidence of postoperative hematoma and decrease wound tension. No conclusive evidence in the literature supports using drains to avoid complications in degenerative lumbar spine surgery. PURPOSE We aimed to evaluate wound drains in patients with lumbar arthrodesis for degenerative disorders based on clinical outcomes, complications, hematocrit, and length of stay. STUDY DESIGN A multicenter randomized prospective controlled clinical trial. PATIENT SAMPLE We enrolled surgical candidates for posterior lumbar decompression and fusion surgery for degenerative disorders from October 2019 to August 2021. Patients were randomized into the drain or nondrain group at nine hospitals. The inclusion criteria were as follows: patients aged 40 to 80 years with lumbar and radicular pain, lumbar degenerative disorder, and primary surgery up to three levels. The exclusion criteria were bleeding abnormalities, bleeding >2,500 mL and dural tears. OUTCOME MEASURES Preoperative data including Oswestry disability index (ODI), SF-36, lumbar and lower extremity visual analog scale (VAS), body mass index (BMI), hematocrit, and temperature were recorded. Surgical parameters, including surgical time, complications, estimated blood loss (EBL), postoperative temperature and hematocrit (days 1 and 4), dressing saturation, and length of hospital stay (LOS), were registered. METHODS The two groups were assessed preoperatively, perioperatively and at the 1-month follow-up. A REDCap database was used for registration. Data analysis was performed using classical statistics. RESULTS One hundred one patients were enrolled using the Redcap database, and 93 patients were evaluated at the final follow-up. Forty-five patients were randomized to the drain group, and 48 were randomized to the nondrain group. The preoperative characteristics were equivalent in both groups: demographic aspects, pain, ODI, SF-36, BMI, hematocrit, and spine pathology. Surgical time, EBL and complications were similar, with no difference between the groups. No difference was found between BMI and complications. No difference was observed in dressing saturation or postoperative temperature between the groups. The postoperative day 4 hematocrit was higher in the nondrain group [36.4% (32-39)] than in the drain group [34% (29.7-37.6)] without statistically differences (p=.054). The LOS was higher in the drain group [4 (3-5) days] than in the nondrain group [3 (2-4) days] (p=.007). The quality-of-life score, SF-36, was higher in the nondrain group [67.9 (53.6-79.2)] than in the drain group [56.7 (49.1-66)] (p=.043). CONCLUSIONS Nondrain patients presented shorter LOS and better outcomes, with similar complication rates. No difference was found between BMI and complications. Based on this study, in patients undergoing primary posterior spinal decompression and fusion up to three levels for degenerative lumbar disorders, we do not recommend the use of postoperative drains.
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Affiliation(s)
- Marcelo Molina
- Department of Orthopaedic Surgery, Spine Center, Clínica Las Condes, Santiago, Chile; Instituto Traumatológico de Santiago, Santiago, Chile; Research and Clinical Epidemiology Unit, Finis Terrae University, Santiago, Chile.
| | - Ramón Torres
- Instituto Traumatológico de Santiago, Santiago, Chile; Department of Orthopaedic Surgery, Clínica Santa Maria, Santiago, Chile
| | - Magdalena Castro
- Research and Clinical Epidemiology Unit, Finis Terrae University, Santiago, Chile
| | | | | | - Maripaz Martinez
- Research and Clinical Epidemiology Unit, Finis Terrae University, Santiago, Chile
| | - Marcos Ganga
- Department of Orthopaedic Surgery, Clínica Santa Maria, Santiago, Chile
| | - Roberto Postigo
- Department of Orthopaedic Surgery, Clínica Universidad de los Andes, Santiago, Chile
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Saleh H, Williamson TK, Passias PG. Perioperative Nutritional Supplementation Decreases Wound Healing Complications Following Elective Lumbar Spine Surgery: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2023; 48:376-383. [PMID: 36730860 DOI: 10.1097/brs.0000000000004522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of malnutrition in patients undergoing lumbar spine surgery ranges from 5% to 50% and is associated with higher rates of surgical site infections, medical complications, longer lengths of stay, and mortality. PURPOSE To determine if perioperative nutritional intervention decreases wound healing complications in patients undergoing lumbar spine surgery. STUDY DESIGN/SETTING A prospective randomized controlled trial. MATERIALS AND METHODS Patients aged 55+ undergoing elective primary lumbar surgery were included. Patients with a preoperative albumin<3.5 g/dL were defined as malnourished. Intervention group received nutritional supplementation (protein shake) twice daily from postoperative day 0 to two weeks postdischarge. Control group was instructed to continue regular daily diets. Primary outcomes included minor in-hospital complications (wound drainage, electrolyte abnormalities, hypotension, ileus, deep venous thrombus) and wound healing complications within 90 days. Secondary outcomes included 90-day emergency room visits, readmissions, and return to the operating room. Baseline data were compared between groups using means comparison tests. Multivariable analysis evaluated association of outcomes with nutritional supplementation. Subanalysis of malnourished patients assessed effects of nutritional supplementation on outcomes. RESULTS One hundred three patients were included. Thirty-seven (35.9%) were considered malnourished preoperatively. Forty-six (44.7%) received nutritional intervention and 57 (55.3%) served as controls. Adjusted analysis found patients receiving supplementation had lower rates of in-hospital minor complications (2.1% vs. 23.2%, P <0.01), and perioperative wound healing complications (3.4% vs. 17.9%, P <0.05). Subgroup analysis of 37 malnourished patients demonstrated that malnourished patients who received perioperative nutritional supplementation had lower rates of minor complications during admission (0.0% vs. 34.4%, P =0.01) and return to the operating room within 90 days (0.0% vs. 12.4%, P =0.04). CONCLUSIONS Over one third of patients undergoing lumbar surgery were malnourished. Nutritional supplementation during the two-week perioperative period decreased rates of minor complications during admission and wound complications within 90 days. Malnourished patients receiving supplementation less often returned to the operating room. To our knowledge, this is the first study to investigate the effects of perioperative nutritional intervention on wound healing complications for patients undergoing elective lumbar spine surgery. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Hesham Saleh
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY
| | - Tyler K Williamson
- Division of Spinal Surgery, Departments of Orthopedic and Neurological Surgery, NYU Langone Medical Center, New York Spine Institute, New York, NY
| | - Peter G Passias
- Division of Spinal Surgery, Departments of Orthopedic and Neurological Surgery, NYU Langone Medical Center, New York Spine Institute, New York, NY
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The role of spine adipose index in predicting the risk for septic spondylodiscitis after lumbar percutaneous laser disc decompression. ACTA BIOMEDICA SCIENTIFICA 2023. [DOI: 10.29413/abs.2023-8.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
The aim. To analyze the role of the spine adipose index (SAI) in predicting the risk of septic spondylodiscitis after lumbar percutaneous laser disk decompression (PLDD).Material and methods. A retrospective observational single-center study was performed. Various clinical and instrumental parameters have been studied, including the spine adipose index, which are potential risk factors for the development of postprocedural septic spondylodiscitis.Results. The study included 219 patients who underwent PLDD for degenerative lumbar disk disease. The average period of postoperative observation was 30.8 ± 13.3 months. Signs of septic spondylodiscitis were detected in 5 (2.28%) cases. Multivariate analysis showed that III degree of anesthesiological risk by the American Society of Anesthesiologists (ASA) scale (p = 0.021), a high value of body mass index (more than 25 kg/m2) (p = 0.043) and a high value of SAI (over 0.7) (p = 0.037) are statistically significantly associated with the development of septic spondylodiscitis in patients who underwent lumbar PLDD.Conclusion. The value of SAI is statistically significantly associated with the development of spondylodiscitis in patients who underwent PLDD for degenerative lumbar disk disease.
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25
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Porter MW, Burdi W, Casavant JD, Eastment MC, Tulloch-Palomino LG. Association between duration of antimicrobial prophylaxis and postoperative outcomes after lumbar spine surgery. Infect Control Hosp Epidemiol 2022; 43:1873-1879. [PMID: 35166198 PMCID: PMC9753085 DOI: 10.1017/ice.2021.529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Accepted: 12/17/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To describe the association between duration of antimicrobial prophylaxis (AMP) and 30-day surgical site infection (SSI), 7-day acute kidney injury (AKI), 90-day Clostridioides difficile infection (CDI), prolonged hospitalization, and 30-day reoperation after lumbar spine surgery for noninfectious indications, and to report adherence to current guidelines. DESIGN Survey. PARTICIPANTS AND SETTING The study cohort comprised 6,198 patients who underwent lumbar spine surgery for noninfectious indications across 137 Veterans' Health Administration surgery centers between 2016 and 2020. METHODS Used univariate and multivariate logistic regression to determine the association between type and duration of AMP with 30-day SSI, 7-day AKI, 90-day CDI, prolonged hospitalization, and 30-day reoperation. RESULTS Only 1,160 participants (18.7%) received the recommended duration of AMP. On multivariate analysis, the use of multiple prophylactic antimicrobials was associated with increased odds of 90-day CDI (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.1-28.2) and 30-day reoperation (aOR, 2.3; 95% CI, 1.2-4.4). Courses of antimicrobials ≥3 days were associated with increased odds of prolonged hospitalization (aOR,1.8; 95% CI, 1.4-2.3) and 30-day reoperation (aOR, 3.5; 95% CI, 2.2-5.7). In univariate analysis, increasing days of AMP was associated with a trend toward increasing odds of 90-day CDI (cOR, 1.4; 95% CI, 1.0-1.8 per additional day; P = .056). CONCLUSIONS Longer courses of AMP after lumbar spine surgery were associated with higher odds of CDI, prolonged hospitalization, and reoperation, but not with lower odds of SSI. However, adherence to the recommended duration of AMP is very low, hinting at a wide evidence-to-practice gap that needs to be addressed by spine surgeons and antimicrobial stewardship programs.
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Affiliation(s)
- Mary W. Porter
- Pharmacy Services, VA Puget Sound Health Care System, Seattle, Washington
| | - William Burdi
- Pharmacy Services, VA Puget Sound Health Care System, Seattle, Washington
| | | | - McKenna C. Eastment
- Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Luis G. Tulloch-Palomino
- Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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26
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Chen F, Wang J, Zhao X, Lv XQ. Interaction of basic diseases and low red blood cell count as critical murderer of wound infection after osteosarcoma resection: Wound infection after osteosarcoma resection. Medicine (Baltimore) 2022; 101:e31074. [PMID: 36221384 PMCID: PMC9542657 DOI: 10.1097/md.0000000000031074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Surgical wound infection is one of the common complications in patients after osteosarcoma resection. It is imperative to grasp the risk factors comprehensively. Therefore, this study aimed to explore the risk factors of wound infection and deeply analyze the correlation between risk factors and wound infection. METHODS The study subjects were 101 patients who underwent osteosarcoma resection between April 2018 and August 2021. The diagnosis of postoperative wound infection was confirmed by postoperative observation of the incision, ultrasound imaging, and pathogenic examination. This study included a series of potential factors, mainly laboratory examination indicators and patients' general information. The statistical methods had Pearson Chi-square test, Spearman-rho correlation test, multifactorial linear regression model, logistic regression analysis, and receiver operating characteristic (ROC) curve. RESULTS Pearson Chi-square test and Spearman correlation test showed that red blood cell (RBC) count (P = .033) and basic diseases (P = .020) were significantly correlated with a surgical wound infection after osteosarcoma resection. Logistic regression analysis manifested that basic disease (OR = 0.121, 95% CI: 0.015-0.960, P = .046) and RBC (OR = 0.296, 95% CI: 0.093-0.944, P = .040) have a clear correlation with whether the patients have surgical wound infection after osteosarcoma resection. And the interaction of basic diseases and RBC could diagnose the surgical wound infection sensitively and accurately (AUC = 0.700, P = .014, 95% CI = 0.564-0.836) via the ROC analysis. CONCLUSION Patients with basic diseases and low RBC were risk factors for surgical wound infection after osteosarcoma resection.
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Affiliation(s)
- Fei Chen
- The Second Department of Orthopedics, Hangzhou Fuyang District First People’s Hospital, Hangzhou, PR China
- * Correspondence: Fei Chen, The Second Department of Orthopedics, Hangzhou Fuyang District First People’s Hospital, No. 429 Beihuan Road, Fuyang District, Hangzhou 311499, PR China (e-mail: )
| | - Jie Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Province, PR China
| | - Xin Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Province, PR China
| | - Xian-qiang Lv
- Department of Urology, The Fourth Hospital of Hebei Medical University, Hebei Province, PR China
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Karamian BA, Mao J, Toci GR, Lambrechts MJ, Canseco JA, Qureshi MA, Silveri O, Minetos PD, Jallo JI, Prasad S, Heller JE, Sharan AD, Harrop JS, Woods BI, Kaye ID, Hilibrand A, Kepler CK, Vaccaro AR, Schroeder GD. Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion. Spine (Phila Pa 1976) 2022; 47:1055-1061. [PMID: 35797595 DOI: 10.1097/brs.0000000000004394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion. SUMMARY OF BACKGROUND DATA SSI is among the most common healthcare-associated complications. As healthcare systems increasingly emphasize the value of delivered care, there is an increased need to understand the clinical impact of SSIs. MATERIALS AND METHODS A retrospective 3:1 (control:SSI) propensity-matched case-control study was conducted for adult patients who underwent thoracolumbar fusion from March 2014 to January 2020 at a single academic institution. Exclusion criteria included less than 18 years of age, incomplete preoperative and one-year postoperative patient-reported outcome measures, and revision surgery. Continuous and categorical data were compared via independent t tests and χ 2 tests, respectively. Intragroup analysis was performed using paired t tests. Regression analysis for ∆ patient-reported outcome measures (postoperative minus preoperative scores) controlled for demographics. The α was set at 0.05. RESULTS A total of 140 patients (105 control, 35 SSI) were included in final analysis. The infections group had a higher rate of readmission (100% vs. 0.95%, P <0.001) and revision surgery (28.6% vs. 12.4%, P =0.048). Both groups improved significantly in Physical Component Score (control: P =0.013, SSI: P =0.039), Oswestry Disability Index (control: P <0.001, SSI: P =0.001), Visual Analog Scale (VAS) Back (both, P <0.001), and VAS Leg (control: P <0.001, SSI: P =0.030). Only the control group improved in Mental Component Score ( P <0.001 vs. SSI: P =0.228), but history of a SSI did not affect one-year improvement in ∆MCS-12 ( P =0.455) on regression analysis. VAS Leg improved significantly less in the infection group (-1.87 vs. -3.59, P =0.039), which was not significant after regression analysis (β=1.75, P =0.050). CONCLUSION Development of SSI after thoracolumbar fusion resulted in increased revision rates but did not influence patient improvement in one-year pain, functional disability, or physical and mental health status.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Mao
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Mahir A Qureshi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Olivia Silveri
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Paul D Minetos
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jack I Jallo
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Srinivas Prasad
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Joshua E Heller
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Is the routine use of systemic antibiotics after spine surgery warranted? A systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2481-2492. [PMID: 35786772 DOI: 10.1007/s00586-022-07294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine whether the published literature supports the current practice of utilizing antibiotics postoperatively in spine surgery. METHODS A systematic review from PubMed and Cochrane Central Register of Controlled trials databases was performed. Search terms used: "Antibiotic Prophylaxis"[Mesh], antibiotic*, antibacterial*, "Spine"[Mesh], "Surgical Procedures, Operative"[Mesh]. Only comparative, clinical studies were included. Those studies with surgical site infection (SSI) criteria that were not similar to the CDC definition were excluded. A meta-analysis for overall SSI was performed. A subgroup analysis was also performed to analyze the outcomes specifically on instrumented groups of patients. A random-effects model was used to calculate risk ratios (RR). Forest plots were used to display RR and 95% confidence intervals (CI). RESULTS Thirteen studies were included (four Randomized-Controlled Trials, three prospective cohorts, and six retrospective). Three different perioperative strategies were used in the selected studies: Group 1: preoperative antibiotic administration (PreopAbx) versus PreopAbx and any type of postoperative antibiotic administration (Pre + postopAbx) (n = 6 studies; 7849 patients); Group 2: Pre + postopAbx ≤ 24 h versus Pre + postopAbx > 24 h (n = 6; 1982); and Group 3: Pre + postopAbx ≤ 48 h versus. Pre + postopAbx ≤ 72 h (n = 1; 502). The meta-analysis performed on Groups 1 and 2 did not show significant effects (RR = 1.27, 95% CI = 0.77, 2.09, and RR = 0.97, 95% CI = 0.64, 1.46, respectively). CONCLUSION A meta-analysis and comprehensive review of the literature show that the routine use of postoperative antibiotics in spine surgery may not be effective in preventing surgical site infections.
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Khan SA, Choudry UK, Salim A, Nathani KR, Enam SA, Shehzad N. Current management trends for surgical site infection after posterior lumbar spinal instrumentation. A systematic review. World Neurosurg 2022; 164:374-380. [PMID: 35671992 DOI: 10.1016/j.wneu.2022.05.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Systematic review OBJECTIVE: The objective of this systematic review is to determine the fate of spinal implants when the patients develop postoperative wound infection after posterior instrumental fusion in a degenerative spine. METHODS A systematic review of the English-language literature (published between January 2001 and July 2020) was undertaken to identify articles documenting the management strategy for surgical-site infections after posterior lumbar spinal fusion. Studies on pedicle screw fixation after trauma, immunocompromised, metastatic spine disease, and combined anterior/posterior approach were excluded. Two independent reviewers assessed the level of evidence quality using the criteria set by the North American Spine Society, and disagreements were resolved by consensus. RESULTS Out of the 3,071 citations identified, 49 met the criteria to undergo full-text review. Outcomes after surgical site infections were studied from a combined pool of 1,150 patients undergone instrumental spinal fusion. The collected data showed that 456 patients (39.97%) had undergone spinal implant removal following SSI while 694 patients (60.03%) had their implants retained until the resolution of SSI. There was an absolute risk reduction of 29% (ARR-0.292) and a relative risk reduction of 50.3% (RRR- 0.503) of implant removal if the patient underwent wound debridement following SSI. The NNT for wound debridement was calculated at 3.31 from our pooled cohort. The absolute risk reduction in implant removal following VAC therapy was 16.6% and relative risk reduction was noted at 40.4%. This led to a high value of NNT at 6.0 patients. There was an absolute risk reduction of 33.5% while a Relative Risk Reduction of 70.7% was estimated in patients undergoing continuous irrigation. CONCLUSION Our review of the literature suggests that successful eradication of surgical site infection after posterior lumbar spinal fusion can be achieved by wound debridement or VAC therapy with appropriate antimicrobial coverage in most cases. Implant removal is generally reserved for cases refractory to the other treatment modalities.
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Affiliation(s)
| | | | - Adnan Salim
- Department of Neurosurgery, Aga Khan University Hospital.
| | | | | | - Noman Shehzad
- Department of Surgery, Yorkshire and Humber Deanery.
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Olsen MA, Greenberg JK, Peacock K, Nickel KB, Fraser VJ, Warren DK. Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion. J Antimicrob Chemother 2022; 77:1178-1184. [PMID: 35040936 PMCID: PMC9126069 DOI: 10.1093/jac/dkab475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/24/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). METHODS Persons aged 10-64 years undergoing spinal fusion between 1 January 2010 and 30 June 2015 were identified in the MarketScan Commercial Database. Complicated patients and those coded for infection from 30 days before to 2 days after the surgical admission were excluded. Outpatient oral antibiotics were identified within 2 days of surgical discharge. SSI was defined using ICD-9-CM diagnosis codes within 90 days of surgery. Generalized linear models were used to determine factors associated with post-discharge prophylactic antibiotic use and with SSI. RESULTS The cohort included 156 446 fusion procedures, with post-discharge prophylactic antibiotics used in 9223 (5.9%) surgeries. SSIs occurred after 2557 (1.6%) procedures. Factors significantly associated with post-discharge prophylactic antibiotics included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. In multivariable analysis, post-discharge prophylactic antibiotic use was not associated with SSI risk after spinal fusion (relative risk 0.98; 95% CI 0.84-1.14). CONCLUSIONS Post-discharge prophylactic oral antibiotics after spinal fusion were used more commonly in patients with major medical comorbidities, more complex surgeries and those with postoperative complications during the surgical admission. After adjusting for surgical complexity and infection risk factors, post-discharge prophylactic antibiotic use was not associated with decreased SSI risk. These results suggest that prolonged prophylactic antibiotic use should be avoided after spine surgery, given the lack of benefit and potential for harm.
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Affiliation(s)
- Margaret A. Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Kate Peacock
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Katelin B. Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Victoria J. Fraser
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Effectiveness of Oral Antibiotic Therapy in Prevention of Postoperative Wound Infection Requiring Surgical Washout In Spine Surgery. World Neurosurg 2022; 163:e275-e282. [PMID: 35364295 DOI: 10.1016/j.wneu.2022.03.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) after spine surgery are a significant cause of morbidity. Surgeons often prescribe oral antibiotics in the postoperative setting for infected-appearing wounds to prevent reoperation for infection; however, the efficacy of this practice has not been well studied. METHODS Neurosurgical spine patients with clinical concerns for SSI at the University of Pennsylvania were retrospectively studied from 2014 to 2018. Clinical predictors of 90-day reoperation for infection despite antibiotic treatment and variables that influenced antibiotic prescription were analyzed. RESULTS Three hundred and ninety-two patients were included in the study. Preoperative albumin level, days elapsed to antibiotic prescription from index surgery, preoperative hemoglobin level, surgical location, gender, discharge disposition, and level of wound concern were significant predictors of reoperation for infection on bivariate analysis. Days elapsed to antibiotic prescription, surgical location, and level of wound concern remained significant after multivariable logistic regression. Variables that significantly predicted prescription of an antibiotic include length of stay, cerebrospinal fluid leak, race, and level of wound concern. Length of stay, race, and level of wound concern remained significant after multivariable analysis. CONCLUSIONS Wound infection remains a challenging problem in spine surgery and it is reasonable to perform early reoperation in patients with high clinical concerns for infection, because bacterial isolates are often resistant to common oral antibiotics. Patients with wounds with low clinical concerns for infection may undergo a trial of oral antibiotics; however, duration of treatment should not be prolonged.
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Wang S, Wang P, Li X, Sun W, Kong C, Lu S. Enhanced recovery after surgery pathway: association with lower incidence of wound complications and severe hypoalbuminemia in patients undergoing posterior lumbar fusion surgery. J Orthop Surg Res 2022; 17:178. [PMID: 35331289 PMCID: PMC8944146 DOI: 10.1186/s13018-022-03070-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Wound complications are associated with worse satisfaction and additional costs in patients undergoing posterior lumbar fusion (PLF) surgery, and the relationship between enhanced recovery after surgery (ERAS) pathway and wound complications remains poorly characterized. Methods In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between the ERAS program and the incidence of postoperative wound-related complications and other complications following PLF surgery; other outcomes included the length of stay (LOS), 90-day hospital and rehabilitation center readmission. Results The average patient age was 65 yr. More patients with old cerebral infarction were in ERAS group (p < 0.01), and other demographics and comorbidities were similar between groups. Patients in the ERAS group had a lower incidence of postoperative wound-related complications than the non-ERAS group (12.4 vs. 17.8%, p = 0.02). The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing (6% vs. 3%, p = 0.02). ERAS group had a lower incidence of severe postoperative hypoalbuminemia (serum albumin less than 30 g/L) (15.8% vs. 9.0% p < 0.01). Additionally, ERAS patients had shorter postoperative LOS (8.0 ± 1.5 vs. 9.5 ± 1.7, p < 0.01), lower rate of readmission within 90 days (1.9% vs. 6.4%, p < 0.01) and discharge to rehabilitation center (4.2% vs. 1.0%, p < 0.01). Conclusion ERAS pathway might help decrease the rates of postoperative wound complications and severe hypoalbuminemia following PLF surgery; additionally, it demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90 days.
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Affiliation(s)
- Shuaikang Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Xiangyu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Wenzhi Sun
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China. .,National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China. .,Beijing Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing, China.
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Liu WC, Ying H, Liao WJ, Li MP, Zhang Y, Luo K, Sun BL, Liu ZL, Liu JM. Using preoperative and intraoperative factors to predict the risk of surgical site infections after lumbar spinal surgery: a machine learning-based study. World Neurosurg 2022; 162:e553-e560. [DOI: 10.1016/j.wneu.2022.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Maielli LF, Tebet MA, Rosa AF, Lima MC, Mistro Neto S, Cavali PTM, Pasqualini W, Risso Neto MÍ. IDENTIFICATION OF RISK FACTORS ASSOCIATED WITH 30-DAY READMISSION OF PATIENTS SUBMITTED TO ANTERIOR OR POSTERIOR ACCESS CERVICAL SPINE SURGERY. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222103262527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aim: To conduct a systematic review of the literature to identify risk factors associated with 30-day readmission of patients submitted to anterior or posterior access cervical spine surgery. Methods: The databases used to select the papers were PubMed, Web of Science, and Cochrane, using the following search strategy: patient AND readmission AND (30 day OR “thirty day” OR 30-day OR thirty-day) AND (spine AND cervical). Results: Initially, 179 papers that satisfied the established search stringwere selected. After reading the titles and abstracts, 46 were excluded from the sample for not effectively discussing the theme proposed for this review. Of the 133 remaining papers, 109 were also excluded after a detailed reading of their content, leaving 24 that were included in the sample for the meta-analysis. Conclusions: The average readmission rate in the studies evaluated was 4.85%. Only the occurrence of infections, as well as the presence of patients classified by the American Society of Anesthesiology (ASA) assessment system with scores greater than III, were causal factors that influenced the readmission of patients. No significant differences were noted when comparing the anterior and posterior surgical access routes. Level of evidence II; Systematic Review of Level II or Level I Studies with discrepant results.
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Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation. Pain Res Manag 2021; 2021:2262837. [PMID: 34659599 PMCID: PMC8516528 DOI: 10.1155/2021/2262837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
Aim To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy. Methods We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups. Results A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3–30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3–62). The inflammatory indicators of Group A were significantly higher than those of Group B (all P < 0.05), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. Summary. The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.
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Xu Y, Fan P, Xu X, Jiang F, Zhang W, Yin X, Liu H, Wang P, Wang Y. [Study of modified subcutaneous lumbar spine index as a predictor for short-term effectiveness in transforaminal lumbar interbody fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:878-885. [PMID: 34308597 DOI: 10.7507/1002-1892.202101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the value of modified subcutaneous lumbar spine index (MSLSI) as a predictor for short-term effectiveness of transforaminal lumbar interbody fusion (TLIF) in treatment of lumbar degenerative disease (LDD). Methods Between February 2014 and October 2019, 450 patients who were diagnosed as LDD and received single-segment TLIF were included in the study. Based on the MSLSI measured by preoperative lumbar MRI, the patients were sorted from small to large and divided into three groups ( n=150). The MSLSI of group A was 0.11-0.49, group B was 0.49-0.73, and group C was 0.73-1.88. There was no significance in gender, age, disease duration, diagnosis, surgical segment, and improved Charlson comorbidity index between groups ( P>0.05). There were significant differences in the subcutaneous adipose depth of the L 4 vertebral body and body mass index (BMI) between groups ( P<0.05). The operation time, intra-operative blood loss, length of incision, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, total drainage volume, antibiotic use time after operation, walking exercise time after operation, hospital stay, the incidences of surgical or non-surgical complications in the three groups were compared. Pearson correlation analysis was used to analyze the correlation between MSLSI and BMI, and partial correlation analysis was used to study the relationship between MSLSI, BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L 4 vertebral body and complications. The Receiver Operating Characteristic (ROC) curve was used to evaluate the value of SLSI and MSLSI in predicting the occurrence of complications after TLIF in treatment of LDD. Results There was no significant difference in operation time, length of incision, antibiotic use time after operation, walking exercise time after operation, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, and total drainage volume between groups ( P>0.05). The amount of intra-operative blood loss in group C was higher than that in groups A and B, and the hospital stay was longer than that in group B, with significant differences ( P<0.05). Surgical complications occurred in 22 cases (14.7%), 25 cases (16.7%), and 39 cases (26.0%) of groups A, B, and C, respectively. There was no significant difference in the incidence between groups ( χ 2=0.826, P=0.662). The incidences of nerve root injury and wound aseptic complications in group C were higher than those in groups A and B, and the incidence of nerve root injury in group B was higher than that in group A, with significant differences ( P<0.05). There were 13 cases (8.7%), 7 cases (4.7%), and 11 cases (7.3%) of non-surgical complications in groups A, B, and C, respectively, with no significant difference ( χ 2=2.128, P=0.345). There was no significant difference in the incidences of cardiovascular complications, urinary system complications, central system complications, and respiratory system complications between groups ( P>0.05). There was a correlation between MSLSI and BMI in 450 patients ( r=0.619, P=0.047). Partial correlation analysis showed that MSLSI was related to wound aseptic complications ( r=0.172, P=0.032), but not related to other surgical and non-surgical complications ( P>0.05). There was no correlation between BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L 4 vertebral body and surgical and non-surgical complications ( P>0.05). ROC curve analysis showed that the area under ROC curve (AUC) of MSLSI was 0.673 (95%CI 0.546-0.761, P=0.025), and the AUC of SLSI was 0.582 (95%CI 0.472-0.693, P=0.191). Conclusion MSLSI can predict the short-term effectiveness of TLIF in treatment of LDD. Patients with high MSLSI suffer more intra-operative blood loss, longer hospital stay, and higher incidence of nerve root injury and postoperative incision complications.
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Affiliation(s)
- Yuzhu Xu
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Pan Fan
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Xuanfei Xu
- Department of Nulear Medicine, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Feng Jiang
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Wei Zhang
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Xiangjie Yin
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Hang Liu
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Peiyang Wang
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Yuntao Wang
- Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P.R.China.,Medical School, Southeast University, Nanjing Jiangsu, 210009, P.R.China
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Timing of Preoperative Surgical Antibiotic Prophylaxis After Primary One-Level to Three-Level Lumbar Fusion. World Neurosurg 2021; 153:e349-e358. [PMID: 34229097 DOI: 10.1016/j.wneu.2021.06.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between timing of preoperative surgical antibiotic prophylaxis and postoperative surgical site infections (SSIs) among patients with 1-level to 3-level lumbar fusion. METHODS Patients having undergone a primary 1-level to 3-level lumbar fusion at a single institution were allocated into 5 groups based on the time from preoperative antibiotic administration to incision (group A, 0-15 minutes; group B, 16-30 minutes; group C, 31-45 minutes; group D, 46-60 minutes; and group E, 61+ minutes). Timing of antibiotic administration as a continuous variable was also analyzed. All patients received irrigation with 3 L of normal saline containing bacitracin as well as local administration of vancomycin powder. SSIs were identified by the definition set forth by the 2017 Centers for Disease Control and Prevention guidelines. RESULTS Among 1131 patients, 27 (2.4%) were found to have an SSI. Compared with patients with antibiotic administration within 0-15 minutes before incision, patients with administration 61+ minutes before incision (group 4) had significantly higher odds of developing an SSI (P < 0.001). Patients had a 1.05-fold higher likelihood of infection for each additional minute delay of administration before incision (P < 0.001). Receiver operating characteristic analysis reported an area under the curve of 0.733 and 0.776 for time as a continuous and categorical variable, respectively. Age (P = 0.02), body mass index (P = 0.03), diabetes mellitus diagnosis (P = 0.04), and type of antibiotic (P = 0.004) were significant predictors of SSI. CONCLUSIONS Our results show that preoperative antibiotic administration beyond 1 hour in patients who have undergone lumbar fusion is associated with higher rates of SSI.
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Hagedorn JM, Misercola B, Comer A, Tari-Blake J, Hoffmann CM, Mehta P, Deer TR. The Team Approach to Spinal Cord and Dorsal Root Ganglion Stimulation: A Guide for the Advanced Practice Provider. Mayo Clin Proc Innov Qual Outcomes 2021; 5:663-669. [PMID: 34195557 PMCID: PMC8240163 DOI: 10.1016/j.mayocpiqo.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jonathan M Hagedorn
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Ashley Comer
- The Spine and Nerve Center of the Virginias, Charleston, WV
| | | | - Chelsey M Hoffmann
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV
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Randomized controlled trial of single-use negative-pressure wound therapy dressings in morbidly obese patients undergoing cesarean delivery. Am J Obstet Gynecol MFM 2021; 3:100410. [PMID: 34058423 DOI: 10.1016/j.ajogmf.2021.100410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The single-use negative-pressure wound therapy dressings are designed to use over a closed surgical wound. Early prospective studies suggested that these dressings may be of potential benefit in reducing cesarean wound complications. OBJECTIVE This study aimed to test the hypothesis that incisional negative-pressure wound therapy decreases postoperative wound morbidity compared with standard surgical dressing in patients with class III obesity undergoing cesarean delivery. STUDY DESIGN In a single-site, parallel, randomized controlled trial, participants with class III obesity (body mass index ≥40 kg/m2) were recruited to participate in the study. Patients were consented in the ambulatory obstetrical units, on admission to the antepartum service, and on labor and delivery before active labor. Patients who had a cesarean delivery were randomized to either the standard surgical dressing or a prophylactic negative-pressure wound therapy device. The randomization was achieved using permuted blocks of 4, 6, and 8 in a 1:1 allocation ratio. The primary outcome was a composite outcome of wound complications. The planned enrollment of 242 subjects was based on the power to detect a 50% decrease in the composite wound outcome, assuming a 30% baseline wound morbidity rate for this population. The outcomes were assessed by study staff blinded to the patient's treatment arm. RESULTS An unplanned interim analysis was performed because of the slow enrollment and publication of larger trials showing no benefit of the negative-pressure wound therapy. Of 411 eligible patients during the study period, 212 participants with class III obesity were enrolled. Of these, 110 underwent cesarean delivery and were subsequently randomized (55 to standard dressing and 55 to prophylactic negative-pressure wound therapy device). The primary outcome occurred in 29.1% in the standard surgical dressing compared with 20% in the negative-pressure wound therapy group (risk difference, 9.1%; 95% confidence interval, -8.3 to 25.8%; P=.38). The study was stopped early because of a low enrollment rate and lower likelihood of seeing a clinically significant benefit. CONCLUSION The trial was stopped after an unplanned, interim analysis showed the use of a prophylactic negative-pressure wound therapy device used for cesarean delivery did not reduce wound complications compared with a standard surgical dressing.
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Shi H, Huang ZH, Huang Y, Zhu L, Jiang ZL, Wang YT, Xie ZY, Wu XT. Which Criterion for Wound Drain Removal is Better Following Posterior 1-Level or 2-Level Lumbar Fusion With Instrumentation: Time Driven or Output Driven? Global Spine J 2021; 13:1017-1023. [PMID: 33942663 DOI: 10.1177/21925682211013770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Case-control study. OBJECTIVES To compare the outcomes of 2 different criteria (time driven and output driven) for wound drain removal and identify which one is better. METHODS 743 patients who underwent posterior lumbar fusion with instrumentation involving 1 or 2 motion segments were enrolled in this study. Based on the different criteria for drain removal, the patients were divided into 2 groups. The drains were discontinued by time driven (postoperative day 2) in group I and output driven (<50 ml per day) in group II. Demographic characteristics, perioperative parameters and clinical outcomes were compared between the 2 groups. RESULTS The demographic characteristics in both groups were comparable. The postoperative drain output, total blood loss, postoperative timing of ambulation, and postoperative duration of hospital stay in group I were lower than those in group II (P < 0.001). There was a higher proportion of patients requiring postoperative blood transfusion in group II, but not to a level of statistical significance (P = 0.054). There was no statistical significant difference in the incidence of surgical site infection (SSI) or symptomatic spinal epidural hematoma (SEH) between the 2 groups (P > 0.05). CONCLUSIONS This study reveals that there are more benefits of wound drain removal by time driven than that by output driven for patients undergoing posterior 1-level or 2-level lumbar fusion with instrumentation, including less postoperative drain output, less total blood loss, earlier postoperative timing of ambulation and less postoperative duration of hospital stay without increasing the incidence of postoperative SSI or symptomatic SEH.
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Affiliation(s)
- Hang Shi
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhi-Hao Huang
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yong Huang
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lei Zhu
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zan-Li Jiang
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yun-Tao Wang
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhi-Yang Xie
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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Palmer AJR, Gagné S, Fergusson DA, Murphy MF, Grammatopoulos G. Blood Management for Elective Orthopaedic Surgery. J Bone Joint Surg Am 2020; 102:1552-1564. [PMID: 32558663 DOI: 10.2106/jbjs.19.01417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | | | | | - Michael F Murphy
- NHS Blood and Transplant and Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Muthu S, Ramakrishnan E, Natarajan KK, Chellamuthu G. Risk-benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2111-2128. [PMID: 32700123 DOI: 10.1007/s00586-020-06540-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/22/2020] [Accepted: 07/13/2020] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Systematic review, meta-analysis, evidence synthesis. OBJECTIVES To analyse the literature evidence available to support the usage of wound drain in various scenarios of spine surgery and provide an evidence summary on the surgical practice. MATERIALS AND METHODS We conducted independent and duplicate electronic database searches adhering to PRISMA guidelines in PubMed, Embase, and Cochrane Library till April 2020. Quality appraisal was done as per Cochrane ROB tool, and evidence synthesis was done as per GRADE approach. Five domains of spine surgery with associated key questions were identified. Evidence tables were generated for each question and critical appraisal done as per the GRADE approach. RESULTS Twenty-three studies (9-RCTs, 4-prospective studies, 10-retrospective studies) were included. Analysis of studies in cervical spine either by anterior or posterior approach and single/multilevel thoracolumbar spinal surgeries did not show any evidence of reduction in surgical site infection (SSI) or haematoma formation with the use of drain. Deformity correction surgeries and surgeries done for trauma or tumour involving spine also did not find any added benefit from the use of wound drains despite increasing the total blood loss. CONCLUSION Evidence from this review suggests that routine use of drain in various domains of spine surgery does not reduce the risk of SSI and their absence did not increase the risk of haematoma formation. The current best evidence is presented with its limitations. High-quality studies to address their use in spine surgeries in cervical, trauma, and tumour domains are required to further strengthen the evidence synthesised from available literature.
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Affiliation(s)
- Sathish Muthu
- Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India.
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
| | - Eswar Ramakrishnan
- Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Karthick Kumar Natarajan
- Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Girinivasan Chellamuthu
- Ganga Hospitals, Coimbatore, Tamil Nadu, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
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