Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization

Evidence-based guideline for the prevention and management of perioperative infection

BACKGROUND

We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels.

METHODS

We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts.

RESULTS

There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the meta-analysis results, recommendations were graded using the Delphi method to generate useful information.

CONCLUSIONS

This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk-benefit trade-off.

Risk factors for surgical site infection following spinal surgery: A meta-analysis

STUDY DESIGN

A meta-analysis.

BACKGROUND

We performed a meta-analysis to explore risk factors of surgical site infection (SSI) following spinal surgery.

METHODS

An extensive search of literature was performed in English database of PubMed, Embase, and Cochrane Library and Chinese database of CNKI and WANFANG (up to October 2020). We collected factors including demographic data and surgical factor. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

RESULTS

Totally, 26 studies were included in the final analysis. In our study, the rate of SSI after spinal surgery was 2.9% (1222 of 41,624). Our data also showed that fusion approach (anterior vs posterior; anterior vs combined), osteotomy, transfusion, a history of diabetes and surgery, hypertension, surgical location (cervical vs thoracic; lumbar vs thoracic), osteoporosis and the number of fusion levels were associated with SSI after spinal surgery. However, age, sex, a history of smoking, body mass index, fusion approach (posterior vs combined), surgical location (cervical vs lumbar), duration of surgery, blood loss, using steroid, dural tear and albumin were not associated with development of SSI.

CONCLUSIONS

In our study, many factors were associated with increased risk of SSI after spinal surgery. We hope this article can provide a reference for spinal surgeons to prevent SSI after spinal surgery.

The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis

BACKGROUND

Lumbar spinal stenosis (LSS) affects mainly elderly patients. To this day, it is unclear whether comorbidities influence treatment success. The aim of this systematic review and meta-analysis was to assess the impact of comorbidities on the treatment effectiveness in symptomatic LSS.

METHODS

We conducted a systematic review and meta-analysis and reviewed prospective or retrospective studies from Medline, Embase, Cochrane Library and CINAHL from inception to May 2020, including adult patients with LSS undergoing surgical or conservative treatment. Main outcomes were satisfaction, functional and symptoms improvement, and adverse events (AE). Proportions of outcomes within two subgroups of a comorbidity were compared with risk ratio (RR) as summary measure. Availability of ≥3 studies for the same subgroup and outcome was required for meta-analysis.

RESULTS

Of 72 publications, 51 studies, mostly assessing surgery, there was no evidence reported that patients with comorbidities were less satisfied compared to patients without comorbidities (RR 1.06, 95% confidence interval (CI) 0.77 to 1.45, I 2 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, I 2 72%). A limited number of studies found no influence of comorbidities on functional and symptoms improvement. Older age did not affect satisfaction, symptoms and functional improvement, and AE (age >80 years RR 1.22, 95% CI 0.98 to 1.52, I 2 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, I 2 58%).

CONCLUSION

In patients with LSS and comorbidities (in particular diabetes), a higher risk for AE should be considered in the treatment decision. Older age alone was not associated with an increased risk for AE, less functional and symptoms improvement, and less treatment satisfaction.

Minimally invasive spine surgery decreases postoperative pain and inflammation for patients with lumbar spinal stenosis

In certain cases, lumbar spinal stenosis may lead to lumbar nervous disorder. A previous study indicated that minimally invasive spine surgery (MISS) presents benefits compared with conventional open surgery (COS). In the current study, the efficacy of MISS and COS for lumbar spinal stenosis patients was investigated. A total of 82 patients with lumbar spinal stenosis were enrolled and divided into two age-matched groups that received MISS (n=41) or COS (n=41). Patient parameters, including symptoms, inflammatory score, visual analog score (VAS), wound length, Oswestry Disability Index (ODI), hospital stay and postoperative outcomes were analyzed in the current study. Outcomes indicated that both MISS and COS significantly improved symptoms of lumbar spinal stenosis compared with the baseline. It was observed that MISS resulted in decreased wound length and hospital stay compared with COS for patients with lumbar spinal stenosis. The results revealed that MISS had better outcomes compared with COS in improving ODI and inflammatory score for patients with lumbar spinal stenosis. Notably, it was identified that MISS exhibited improved VAS for back and leg pain compared with the COS group for patients with lumbar spinal stenosis. In conclusion, these outcomes indicate that MISS was more effective compared with COS for improving symptoms in patients with lumbar stenosis.

Clinical Outcomes Associated With Allogeneic Red Blood Cell Transfusions in Spinal Surgery: A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVES

The objectives of this systematic review were to report the available clinical evidence on patient outcomes associated with perioperative allogeneic red blood cell (RBC) transfusions in adult patients undergoing spinal surgery and to determine whether there is any evidence to support an association between transfusion timing and clinical outcomes.

METHODS

A systematic review of the PubMed, EMBASE, and Cochrane Library databases was performed to identify all articles examining outcomes of adult spinal surgery patients who received perioperative allogeneic RBC transfusions. The level of evidence for each study was assessed using the "Oxford Levels of Evidence 2" classification system. Meta-analysis was not performed due to the heterogeneity of reports.

RESULTS

A total of 2759 unique citations were identified and 76 studies underwent full-text review. Thirty-four studies were selected for analysis. All the studies, except one, were retrospective. Eleven studies investigated intraoperative or postoperative transfusions. Only one article compared outcomes related to intraoperative versus postoperative transfusions.

CONCLUSIONS

Perioperative transfusion is associated with increased rates of postoperative complications, especially infectious complications, and prolonged length of stay. Some evidence suggests that a dose-response relationship may exist between morbid events and the number of RBC units administered, but these findings are inconsistent. Because of the heterogeneity of reports and inconsistent findings, the incidence of specific complications remains unclear. Limited research activity has focused on intraoperative versus postoperative transfusions, or the effect of transfusion on functional outcomes of spine surgery patients. Further research is warranted to address these clinical issues.

A cross-sectional study of surgical glove perforation during the posterior lumbar interbody spinal fusion surgery: Its frequency, location, and risk factors

Lumbar fusion surgery was known to pose a greater risk of surgical glove perforation. However, there has been no study on the glove perforation that can transmit the blood-borne disease to the patient and surgical staff members in the posterior lumbar interbody fusion surgery (PLIFs).We performed a cross-sectional study to investigate the glove perforation during the PLIFs. The study included 37 consecutive patients (10 males and 27 females). All used gloves of surgical staff members, which included the surgeon, assistant surgeons, bone trimmer (who performed local bone trimming and interbody cage preparation), and scrub nurse were collected and were performed to the pinhole water infusion test. The characteristics (i.e., frequency and location of perforated glove) and relative risk of glove perforation were investigated for each participant. The independent risk factors influencing glove perforation were analyzed by multiple logistic regression analysis.The overall operative perforation rate which is a percentage of detected more than one glove perforated event in all cases was 51.4%. The overall glove perforation rate which is the percentage of perforated gloves in all gloves used for surgery was 3.8%. The relative risk of glove perforation by each participant was 2.38 in the surgeon (P = .002), 1.36 in the bone trimmer (P = .04), 1.36 in the scrub nurse (P = .04), and 1.19 in assistant surgeons (P = .13). And, the volume of trimmed local bone was analyzed as an independent risk factor for glove perforation (ORs = 1.310, P = .02).The overall operative perforation rate in PLIFs is higher than 50%. The surgeon, scrub nurse and bone trimmer were observed as a significant risk factor for glove perforation. And, the volume of trimmed local bone was analyzed as independent risk factor. Since the preparation of the interbody cage is essential for successful lumbar fusion surgery, the bone trimmer must pay attention to the glove perforation during this procedure.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation.

Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000.

Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence.

Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis

OBJECTIVES

Lumbar spinal stenosis (LSS) in the elderly may result in a progressive narrowing of the spinal canal leading to compression of nerve roots in some individuals. The aim of this study was to evaluate the quality of life changes after minimally invasive decompression surgery without instrumentation in geriatric patients with lumbar spinal stenosis.

PATIENTS AND METHODS

This prospective clinical study included 37 patients with American Society of Anesthesiologists (ASA) II-III scores between the ages of 65 and 86 years, who were planned to undergo surgical intervention due to LSS. All patients had neurogenic claudication and pain in the hips, thighs, and legs. Measurements of the osseous spinal canal were evaluated by magnetic resonance imaging. Before the surgical intervention, patient demographics and clinical characteristics were recorded. The Short-Form-36 test, the Oswestry Disability Index, and the Visual Analog Scale were applied to all patients preoperatively and two years postoperatively.

RESULTS

In the study population, 11 patients had single level of spinal stenosis, 20 patients had two levels of spinal stenosis, and six patients had three levels of spinal stenosis. There were significant differences between the preoperative and postoperative ODI and VAS scores. There was a statistically significant difference in all subscales of the SF-36 test with the exception of general health scores. Three patients who had dural damage during the operation were treated with bio glue. Also, no patients were recorded to have any neurological deficits and root injuries postoperatively.

CONCLUSION

Minimally invasive decompression surgery, without instrumentation, for lumbar spinal stenosis in geriatric patients significantly improves the patients' quality of life.