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Yang YF, Yu JC, Xiao Z, Kang YJ, Zhou B. Role of Pre-Operative Nutrition Status on Surgical Site Infection After Posterior Lumbar Interbody Fusion: A Retrospective Study. Surg Infect (Larchmt) 2023; 24:942-948. [PMID: 38016129 DOI: 10.1089/sur.2023.051] [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: 11/30/2023] Open
Abstract
Background: A retrospective case-control study to determine the role of pre-operative systemic and local nutritional factors on patients developing a surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). Surgical site infection after PLIF remains a substantial cause of morbidity. The literature demonstrates the prognosis of surgical patients is associated with pre-operative nutritional status that not only includes systemic nutritional factors, such as prognostic nutritional index (PNI), body mass index (BMI), and serum albumin, but also local nutritional factors, such as subcutaneous fat thickness at the surgical site, including absolute fat thickness and relative fat thickness. However, the role of pre-operative nutrition status in SSI after PLIF surgery remains unclear. Patients and Method: A retrospective review was performed on a consecutive cohort of 766 consecutive adult patients who underwent PLIF surgery for lumbar degenerative conditions between 2020 and 2021 at Second Xiangya Hospital. Previously identified risk factors as well as systemic and local nutritional factors nutritional factors were collected. Results: Among the 766 patients, 38 had post-operative SSI including 15 superficial SSI and 23 deep SSI. Univariable analysis showed that body weight, BMI, PNI, serum albumin, and relative fat thickness differed between the SSI and non-SSI groups. Multivariable logistic regression analysis showed that pre-operative PNI and relative fat thickness were independently associated with SSI after PLIF surgery. Conclusions: Lower pre-operative PNI and higher relative fat thickness are independent risk factors for developing deep SSI after PLIF.
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Affiliation(s)
- Yi-Fan Yang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun-Cheng Yu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhen Xiao
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Jun Kang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bin Zhou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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Ansorge A, Betz M, Wetzel O, Burkhard MD, Dichovski I, Farshad M, Uçkay I. Perioperative Urinary Catheter Use and Association to (Gram-Negative) Surgical Site Infection after Spine Surgery. Infect Dis Rep 2023; 15:717-725. [PMID: 37987402 PMCID: PMC10660755 DOI: 10.3390/idr15060064] [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: 08/28/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
This study evaluates potential associations between the perioperative urinary catheter (UC) carriage and (Gram-negative) surgical site infections (SSIs) after spine surgery. It is a retrospective, single-center, case-control study stratifying group comparisons, case-mix adjustments using multivariate logistic regression analyses. Around half of the patients (2734/5485 surgeries) carried a UC for 1 day (median duration) (interquartile range, 1-1 days). Patients with perioperative UC carriage were compared to those without regarding SSI, in general, and Gram-negative, exclusively. The SSI rate was 1.2% (67/5485), yielding 67 revision surgeries. Gram-negative pathogens caused 16 SSIs. Seven Gram-negative episodes revealed the same pathogen concomitantly in the urine and the spine. In the multivariate analysis, the UC carriage duration was associated with SSI (OR 1.1, 95% confidence interval 1.1-1.1), albeit less than classical risk factors like diabetes (OR 2.2, 95%CI 1.1-4.2), smoking (OR 2.4, 95%CI 1.4-4.3), or higher ASA-Scores (OR 2.3, 95%CI 1.4-3.6). In the second multivariate analysis targeting Gram-negative SSIs, the female sex (OR 3.8, 95%CI 1.4-10.6) and a UC carriage > 1 day (OR 5.5, 95%CI 1.5-20.3) were associated with Gram-negative SSIs. Gram-negative SSIs after spine surgery seem associated with perioperative UC carriage, especially in women. Other SSI risk factors are diabetes, smoking, and higher ASA scores.
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Affiliation(s)
- Alexandre Ansorge
- University Spine Centre Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Michael Betz
- University Spine Centre Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Oliver Wetzel
- University Spine Centre Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Marco Dimitri Burkhard
- University Spine Centre Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Igor Dichovski
- University Spine Centre Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mazda Farshad
- University Spine Centre Zürich, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ilker Uçkay
- Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Infectiology and Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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García-Pérez D, García-Posadas G, San-Juan R, Brañas P, Panero-Pérez I, Delgado-Fernández J, Paredes I. A prospective study to identify preoperative serum parameters for spinal implant infection detected by sonication fluid culture. 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 2023; 32:1818-1829. [PMID: 36897428 DOI: 10.1007/s00586-023-07628-1] [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: 10/26/2022] [Revised: 01/03/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Low-virulent microorganisms identified on pedicle screws by sonication fluid culture (SFC) are an important cause of implant loosening. While sonication of explanted material improves the detection rate, the risk of contamination exists and no standardized diagnostic criteria for chronic low-grade spinal implant-related infection (CLGSII) are stablished. Besides, the role of serum C-reactive protein (CRP) and procalcitonin (PCT) in CLGSII has not been adequately investigated. METHODS Blood samples were collected prior to implant removal. To increase sensitivity, the explanted screws were sonicated and processed separately. Patients exhibiting at least one positive SFC were classified in the infection group (loose criteria). To increase specificity, the strict criteria only considered multiple positive SFC (≥ 3 implants and/or ≥ 50% of explanted devices) as meaningful for CLGSII. Factors which might promote implant infection were also recorded. RESULTS Thirty-six patients and 200 screws were included. Among them, 18 (50%) patients had any positive SFCs (loose criteria), whereas 11 (31%) patients fulfilled the strict criteria for CLGSII. Higher serum protein level was the most accurate marker for the preoperative detection of CLGSSI, exhibiting an area under the curve of 0.702 (loose criteria) and 0.819 (strict criteria) for the diagnosis of CLGSII. CRP only exhibited a modest accuracy, whereas PCT was not a reliable biomarker. Patient history (spinal trauma, ICU hospitalization and/or previous wound-related complications) increased the likelihood of CLGSII. CONCLUSION Markers of systemic inflammation (serum protein level) and patient history should be employed to stratify preoperative risk of CLGSII and decide the best treatment strategy.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain.
- Department of Neurosurgery, Complejo Universitario Hospital Albacete, Calle Hermanos Falcó 37, 02008, Albacete, Spain.
| | - Guillermo García-Posadas
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Patricia Brañas
- Department of Clinical Microbiology, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Irene Panero-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Juan Delgado-Fernández
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
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Nagaoki T, Kumagai G, Wada K, Tanaka S, Asari T, Ishibashi Y. Association between Preoperative Urine Culture and Urinary Tract Infection after Spinal Surgery. Asian Spine J 2023; 17:176-184. [PMID: 35989508 PMCID: PMC9977977 DOI: 10.31616/asj.2021.0533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This is a retrospective study. PURPOSE This study assessed risk factors accounting for urinary tract infections (UTIs) to determine whether preoperative asymptomatic UTI (aUTI) could be used to predict UTIs in patients after spinal surgery. OVERVIEW OF LITERATURE UTI is a spinal surgery complication that increases the incidence of surgical site infections. However, the risk factors for UTIs after spinal surgery remain unclear. METHODS This study included 509 (mean age, 54.5 years; 239 males and 270 females) patients who underwent posterior spine surgery at the department of the current study. First, clean catch urine was collected, after which a urine culture was performed for all patients before surgery. Preoperative detection of the aUTI (>105 colony-forming units/mL) rate was then determined. Subsequently, risk factors for postoperative UTI were evaluated using logistic regression analysis with the following as independent variables: age, sex, obesity, diabetes, spinal cord tumor, the preoperative Japanese Orthopedic Association (JOA) score, JOA-bladder function, preoperative urine culture positivity, aUTI, preoperative Escherichia coli detection, the postoperative catheter placement period, instrumentation, number of surgical levels, surgery duration, and blood loss. RESULTS The preoperative aUTI and postoperative UTI incidences were 8.1% and 4.1%, respectively. Furthermore, multivariate logistic analysis showed that the risk factor for postoperative UTI was preoperative aUTI (odds ratio, 4.234; 95% confidence interval, 1.532-11.702; p=0.005). CONCLUSIONS Preoperative aUTI is a risk factor for UTI in patients after spinal surgery.
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Affiliation(s)
- Toshihide Nagaoki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sunao Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Anastasio AT, Guisse NF, Farley KX, Rhee JM. Hospital Burdens of Patients With Cerebral Palsy Undergoing Posterior Spinal Fusion for Scoliosis. Global Spine J 2022; 12:883-889. [PMID: 33203253 PMCID: PMC9344497 DOI: 10.1177/2192568220968542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Many patients undergoing posterior spinal fusion (PSF) for scoliosis have concurrent cerebral palsy (CP), which is associated with many medical comorbidities and inherent operative risk. We aimed to quantify the contribution of CP to increased cost, length of stay (LOS), and complication rates in patients with scoliosis undergoing PSF. METHODS Using the National Inpatient Sample database, we collected data regarding patient demographics, hospital characteristics, comorbidities, in-hospital complications, and mortality. Primary outcomes included complications, hospital LOS, and total hospital costs. Multivariate regression models assessed the contribution of CP to in-hospital complications, discharge status, and mortality. Linear regression identified the contribution of a diagnosis of CP on hospital LOS and inflation-adjusted cost. RESULTS Cerebral palsy was an independent predictor of several complications. The most striking differences were seen for mortality (odds ratio [OR]: 3.40, P < .001), a postoperative requirement for total parenteral nutrition (OR: 3.16, P < .001), urinary tract infection (OR: 2.75, P < .001), surgical site infection (OR: 2.67, P < .001), and pneumonia (2.21, P < .001). Patients with CP ultimately cost an additional $13 482 (P < .001) with a 2.07-day greater LOS (P < .001) than patients without CP. CONCLUSION Most complications were seen in higher rates in the CP cohort, with higher cost and LOS in patients with CP versus those with idiopathic scoliosis (IS). Our findings represent important areas of emphasis during preoperative consultations with patients with CP and their families. Extra care in patient selection and multifaceted treatment protocols should continue to be implemented with further investigation on how to mitigate common complications.
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Affiliation(s)
| | - Ndeye F. Guisse
- Emory University, Atlanta, GA, USA
- Ndeye F. Guisse, 7 Executive Park Drive NE,
Apt 1314, Atlanta, GA 30329, USA.
| | | | - John M. Rhee
- Emory University, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
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Choi JHK, Duong HA, Williams S, Lee J, Oh M, Rosen C, Lee YP, Bhatia N. The efficacy of bactrim in reducing surgical site infections after spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 9:100095. [PMID: 35141659 PMCID: PMC8820075 DOI: 10.1016/j.xnsj.2021.100095] [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: 09/22/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous studies show an increasing incidence of gram-negative organisms in surgical site infections after spine surgery. This study is looking for the association of the post-operative prophylactic use of Bactrim and the gram-negative surgical site infection after lumbar spine surgery. METHODS Patients who underwent lumbar spine surgery between August 2010 and December 2019 at the institution were retrospectively reviewed. RESULTS There were 11 infections out of 511 cases where no oral antibiotics were given (2.2%). There were 2 infections out of 84 cases where Bactrim was given (2.4%). This was not statistically significant (P=0.89). The organisms cultured from the no oral antibiotic group were 8 cases of methicillin sensitive Staphylococcus aureus (MSSA), 1 case of E. coli, 1 case of Pseudomonas aeruginosa, 1 case of MRSA. The organisms cultured from the Bactrim group were 1 case of MRSA, and 1 case of combined Citrobacter freundii and methicillin sensitive Staphylococcus aureus (MSSA). CONCLUSION There was no statistically significant difference in SSIs when Bactrim was given for two weeks after surgery. However, two subjects who developed infection from the Bactrim group were paradoxically affected by gram-negative and antibiotic resistant organisms. So, clinicians should be judicious in their use of oral antibiotics after spine surgery. Level of Evidence: III.
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Affiliation(s)
- Jeffrey Hyun-Kyu Choi
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Huy Alex Duong
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Sean Williams
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Joshua Lee
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Charles Rosen
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California, Irvine, CA, United States
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Alomari S, Liu A, Westbroek E, Witham T, Bydon A, Lo SFL. Effect of patient's sex on early perioperative outcomes following anterior cervical discectomy and fusion. J Clin Neurosci 2021; 93:247-252. [PMID: 34656256 DOI: 10.1016/j.jocn.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Differences in morbidity and mortality measures between males and females have been demonstrated for a variety of spinal surgeries, however, studies of anterior cervical discectomy and fusion (ACDF) are limited. To investigate the impact ofsexon 30-day perioperative outcomes of ACDF. METHODS Retrospective 1:1 propensity score-matched cohort study. Patients who underwent ACDF between 2016 and 2018 were reviewed from the ACS-NSQIP database.Propensity score matchingand subgroup analysis were used. RESULTS 21,180 patients met inclusion criteria. 11,194 patients underwent single-level ACDF and 9986 patients underwent multi-level ACDF. In the single-level group, there were 6168 (55.1%) males and 5026 (44.9%) females. In the multi-level group, there were 5033 (50.4%) males and 4953 (49.6%) females. In both single/multi-level groups, females were more likely to be of older age, be functionally dependent, and have higher BMI and lower preoperative hematocrit level. Males were more likely to be Caucasian, smokers, have myelopathy, diabetes mellitus, hypertension and bleeding disorders. In both single/multi-level groups, except for the higher incidence of urinary tract infection (UTI) in females and myocardial infarction (MI) in males, there were no significant differences in morbidity and mortality between males and females. CONCLUSIONS Several differences in demographics and baseline health status exist between males and females undergoing ACDF. When attempting to control for comorbid conditions, we found that sex by itself is not an independent risk factor for higher perioperative morbidity or mortality in patients undergoing ACDF, except for the higher incidence of UTI in females and MI in males. These results are important findings for clinicians and spine surgeons while counseling patients undergoing this type of procedure.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Erick Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Incidences and reasons of postoperative surgical site infection after lumbar spinal surgery: a large population study. 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 2021; 31:482-488. [PMID: 34410502 DOI: 10.1007/s00586-021-06967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/15/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidences of postoperative acute surgical site infection (SSI) after lumbar spinal surgery and its possible reasons in our hospital during the past 9 years. METHODS This is a retrospective study with a large sample size. The medical records of all included patients were reviewed, and patients with acute SSI were identified. The incidence and possible reasons of SSI were determined. RESULTS A total of 7240 patients who underwent posterior lumbar spinal surgery were included in this study, and the total incidence of postoperative SSI was 1.53% (111/7240). Gram-negative bacteria were found to be dominant in postoperative wound infections after lumbar spinal surgery. And Escherichia coli were the most common pathogen in patients with SSI. The rate of postoperative SSI following lumbar spinal surgery was increased at first and then decreased during the past 9 years. Additionally, from 2011 to 2014, it was mainly deep infection in these patients, and then was mainly superficial infection from 2015 to 2019. Patients with lumbar spinal stenosis had the highest incidence of postoperative SSI (2.39%, P < 0.001). There was also a significant difference for the number of SSI cases among different surgeons. CONCLUSION Based on a large population analysis, Gram-negative bacteria were the most common pathogen in postoperative SSI after lumbar spinal surgery. And patients with lumbar spinal stenosis had the highest incidence of SSI. Increasing the intervention of Gram-negative may be an important step to reduce the postoperative SSI after lumbar spinal surgery.
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Benavent E, Rodríguez-Pardo D, Ulldemolins M, Sobrino-Diaz B, Bustinduy MJ, Escudero-Sanchez R, Nodar A, Sorli L, Del Toro López MD, Bahamonde A, Vilchez HH, Duran J, Muñez E, Rodriguez-Montserrat D, García-País MJ, Pellisé F, Núñez-Pereira S, Caballero-Martinez LF, Cobo J, Pérez-Rodríguez MT, Ariza J, Pigrau C, Murillo O. Infections after spine instrumentation: effectiveness of short antibiotic treatment in a large multicentre cohort. J Antimicrob Chemother 2021; 76:1085-1093. [PMID: 33496335 DOI: 10.1093/jac/dkaa548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Available information about infection after spine instrumentation (IASI) and its management are scarce. We aimed to analyse DAIR (debridement, antibiotics and implant retention) prognosis and evaluate effectiveness of short antibiotic courses on early forms. METHODS Multicentre retrospective study of patients with IASI managed surgically (January 2010-December 2016). Risk factors for failure were analysed by multivariate Cox regression and differences between short and long antibiotic treatment were evaluated with a propensity score-matched analysis. RESULTS Of the 411 IASI cases, 300 (73%) presented in the first month after surgery, 48 in the second month, 22 in the third and 41 thereafter. Infections within the first 2 months (early cases) occurred mainly to older patients, with local inflammatory signs and predominance of Enterobacteriaceae, unlike those in the later periods. When managed with DAIR, prognosis of early cases was better than later ones (failure rate 10.4% versus 26.1%, respectively; P = 0.02). Risk factors for DAIR failure in early cases were female sex, Charlson Score, large fusions (>6 levels) and polymicrobial infections (adjusted HRs of 2.4, 1.3, 2.6 and 2.26, respectively). Propensity score matching proved shorter courses of antibiotics (4-6 weeks) as effective as longer courses (failure rates 11.4% and 10.5%, respectively; P = 0.870). CONCLUSIONS IASIs within the first 2 months could be managed effectively with DAIR and shorter antibiotic courses. Clinicians should be cautious when faced with patients with comorbidities, large fusions and/or polymicrobial infections.
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Affiliation(s)
- Eva Benavent
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Dolors Rodríguez-Pardo
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Ulldemolins
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Sobrino-Diaz
- Department of Infectious Diseases, Hospital Regional Universitario Málaga, Málaga, Spain
| | | | - Rosa Escudero-Sanchez
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Disease Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Andrés Nodar
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Luisa Sorli
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - María Dolores Del Toro López
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, CSIC, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Alberto Bahamonde
- Department of Internal Medicine-Infectious Diseases, Hospital Universitario del Bierzo, León, Spain
| | - Helem H Vilchez
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Joan Duran
- Infectious Diseases Department, Hospital Parc Tauli de Sabadell, University Autonoma of Barcelona, Barcelona, Spain
| | - Elena Muñez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - María José García-País
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Ferran Pellisé
- Department of Orthopaedic Surgery, Spine Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Susana Núñez-Pereira
- Department of Orthopaedic Surgery, Hospital Universitario Donostia, Gipuzkoa, Spain
| | | | - Javier Cobo
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Disease Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Javier Ariza
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Pigrau
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain
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Alomari S, Liu A, Westbroek E, Witham T, Bydon A, Larry Lo SF. Influence of Sex on Early Outcomes of Elective Lumbar Fusions: An Updated Propensity-Matched and Subgroup Analysis. World Neurosurg 2021; 150:e388-e399. [PMID: 33722719 DOI: 10.1016/j.wneu.2021.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Existing data have demonstrated significant differences in morbidity and mortality measures between men and women undergoing various spinal surgeries. However, studies of lumbar fusion surgery have been limited. Thus, we investigated the effects of patient sex on 30-day perioperative outcomes after elective lumbar fusion spine surgery. METHODS Patients who had undergone lumbar fusion from 2015 to 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching was used to determine whether the patient's sex had influenced the 30-day perioperative complications. RESULTS A total of 44,526 cases had met the inclusion criteria and were reviewed. Of the 44,526 patients, 13,715 had undergone posterior lumbar fusion, 21,993 had undergone posterior/transforaminal lumbar interbody fusion, and 8818 had undergone anterior/lateral lumbar interbody fusion. The women were more likely to be older, functionally dependent, and taking steroids for chronic conditions and to have a higher body mass index and lower preoperative hematocrit level. The men were more likely to be white, to smoke, and to have diabetes mellitus, hypertension, and bleeding disorders. In all cohorts, except for a higher incidence of urinary tract infection in the female patients and myocardial infarction in the male patients, no significant differences were found in morbidity and mortality between the sexes. CONCLUSIONS Several differences in demographics and baseline health status were found between men and women undergoing lumbar fusion. When attempting to control for comorbid conditions using propensity score matching, we found that sex was an independent predictor of urinary tract infection in women and myocardial infarction in men across major morbidity and mortality categories in patients undergoing lumbar fusion surgery.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erick Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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11
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Pertsch NJ, Darveau SC, Tang OY, Toms SA, Weil RJ. Urinary Tract Infection after Elective Spine Surgery: Timing, Predictive Factors, and Outcomes. Spine (Phila Pa 1976) 2021; 46:337-346. [PMID: 33534444 DOI: 10.1097/brs.0000000000003794] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether postoperative UTI timing affects short-term outcomes. SUMMARY OF BACKGROUND DATA Urinary tract infection (UTI) is a common post-surgical complication; however, the predominant timing, location, and potential differential effects have not been carefully studied. METHODS We analyzed elective spine surgery patients from 2012 to 2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We grouped patients with postoperative UTI by day of onset relative to discharge, to create cohorts of patients who developed inpatient UTI and post-discharge UTI. We compared both UTI cohorts with a control (no UTI) population and with each other to identify differences in baseline characteristics including demographic, comorbidity and operative factors. We performed multivariate logistic regression to identify predictors of UTI in each cohort and to assess adjusted risks of poor outcomes associated with UTI timing. RESULTS A total of 289,121 patients met inclusion criteria and 0.88% developed UTI (n = 2553). Only 31.6% of UTIs occurred before discharge (n = 806), with 68.4% occurring after discharge (n = 1747). The inpatient UTI cohort had significantly longer operative time, more fusion procedures, more posterior procedures, and more procedures involving the lumbar levels than the post-discharge cohort. Predictors of inpatient UTI included procedure type, spine region, and approach. Predictors of post-discharge UTI included length-of-stay and discharge destination. Both UTI cohorts were significantly associated with sepsis; however, post-discharge UTI carried a higher odds (adjusted odds ratio [aOR] = 24.90, 95% confidence interval [CI] = 21.05-29.45, P < 0.001 vs. aOR = 14.31, 95% CI = 11.09-18.45, P < 0.001). Inpatient UTI was not associated with 30-day readmission, although post-discharge UTI was (aOR = 8.23, 95% CI = 7.36-9.20, P < 0.001). Conversely, inpatient UTI was associated with increased odds of 30-day mortality (aOR = 3.23, 95% CI = 1.62-6.41, P = 0.001), but post-discharge UTI was not. CONCLUSION Predictive factors and outcomes differ based on timing of UTI after elective spine surgery. Before discharge, procedure -specific details predict UTI, but after discharge they do not. These findings suggest that traditional thinking about UTI prevention may need modification.Level of Evidence: 3.
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Affiliation(s)
- Nathan J Pertsch
- The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Spencer C Darveau
- The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Oliver Y Tang
- The Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Steven A Toms
- The Warren Alpert School of Medicine, Brown University, Providence, RI
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI
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12
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Ziółkowski G, Pawłowska I, Stasiowski M, Jachowicz E, Wójkowska-Mach J, Bielecki T. Multidrug-Resistant Micro-Organisms Associated with Urinary Tract Infections in Orthopedic Patients: A Retrospective Laboratory-Based Study. Antibiotics (Basel) 2020; 10:antibiotics10010007. [PMID: 33374781 PMCID: PMC7823999 DOI: 10.3390/antibiotics10010007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 01/24/2023] Open
Abstract
Background: The risk of healthcare-associated infections (HAIs) in surgical wards remains closely related to the type of surgery and procedures performed on patients. Those factors also condition the risk of various forms of clinical infections, especially urinary tract infections (UTIs). UTIs are most frequently (70–80% of cases) caused by the use of bladder catheter in the perioperative period. The aim of this study was to perform an epidemiological and microbiological analysis of UTIs in orthopedic patients, with an emphasis on multidrug-resistant (MDR) micro-organisms. Methods: The study was conducted in a 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5239 patients, operated on in 2013–2015, were included in the study. The urinary catheter use rate was 30.7%. Laboratory-based study used the UTI definition of the HAI-Net program. A micro-organism was declared MDR if it was resistant to at least one antibiotic from three or more groups of antibacterial drugs, and extensively drug-resistant (XDR) if it was sensitive to antibiotics from no more than two groups of drugs. Results: The UTI incidence was 3.2% (168 cases), the CA-UTI incidence density was 9.6/1000 catheter days. The highest risk of UTI was found in patients aged 75 or older. Monomicrobial cultures were detected in 163 specimens (78% of all microbiologically confirmed UTIs). Gram-negative flora prevailed among the micro-organisms, the predominantly isolated Enterobacteriaceae being Escherichiacoli and Klebsiellapneumoniae. In 16 patients (7.7% of microbiologically confirmed UTIs), yeast infection was confirmed. Isolated micro-organisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones (37–64%), as well as to trimethoprim-sulfamethoxazole (50%). The MDR prevalence was 24.4%. Conclusions: The presented data indicates that UTIs are a significant problem in the studied population, so is antimicrobial resistance, especially to quinolones, and extended-spectrum cephalosporins, which are often used as first-line therapy. To tackle the problem of high UTI incidence and MDR prevalence, reducing the UTI risk factors should be prioritized.
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Affiliation(s)
- Grzegorz Ziółkowski
- Sosnowiec Medical College, Wojska Polskiego 6 Str., 41-200 Sosnowiec, Poland;
| | - Iwona Pawłowska
- Division of Microbiology and Epidemiology, St. Barbara Specialised Regional Hospital No. 5, Medyków 1 Square, 41-200 Sosnowiec, Poland;
| | - Michał Stasiowski
- Clinical Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
- Department of Anaesthesiology and Intensive Therapy, St. Barbara’s Memorial Regional Hospital in Sosnowiec, Plac Medyków 1, 41-200 Sosnowiec, Poland
| | - Estera Jachowicz
- Department of Microbiology, Faculty of Medicine Jagiellonian University Medical College, 31-121 Kraków (Cracow), Poland;
- Correspondence: ; Tel.: +48-12-633-00-60; Fax: +48-12-423-39-24
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine Jagiellonian University Medical College, 31-121 Kraków (Cracow), Poland;
| | - Tomasz Bielecki
- Department of Orthopedics of the Faculty of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
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13
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Lim V, Mac-Thiong JM, Dionne A, Begin J, Richard-Denis A. Clinical Protocol for Identifying and Managing Bladder Dysfunction during Acute Care after Traumatic Spinal Cord Injury. J Neurotrauma 2020; 38:718-724. [PMID: 33121377 DOI: 10.1089/neu.2020.7190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bladder dysfunction is widespread following traumatic spinal cord injury (TSCI). Early diagnosis of bladder dysfunction is crucial in preventing complications, determining prognosis, and planning rehabilitation. We aim to suggest the first clinical protocol specifically designed to evaluate and manage bladder dysfunction in TSCI patients during acute care. A retrospective cohort study was conducted on 101 patients admitted for an acute TSCI between C1 and T12. Following spinal surgery, presence of voluntary anal contraction (VAC) was used as a criterion for removal of indwelling catheter and initiating trial of void (TOV). Absence of bladder dysfunction was determined from three consecutive post-void bladder scan residuals ≤200 mL without incontinence. All patients were reassessed 3 months post-injury using the Spinal Cord Independence Measure (SCIM). A total of 74.3% were diagnosed with bladder dysfunction during acute care, while 57.4% had a motor-complete TSCI. Three months later, 94.7% of them reported impaired bladder function. None of the patients discharged from acute care after a functional bladder was diagnosed reported impaired bladder function at the 3-month follow-up. A total of 95.7% patients without VAC had persisting impaired bladder function at follow-up. The proposed protocol is specifically adapted to the dynamic nature of neurogenic bladder function following TSCI. The assessment of VAC into the protocol provides major insight on the potential for reaching adequate bladder function during the subacute phase. Conducting TOV using bladder scan residuals in patients with VAC is a non-invasive and easy method to discriminate between a functional and an impaired bladder following acute TSCI.
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Affiliation(s)
- Victor Lim
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada
| | - Antoine Dionne
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean Begin
- Department of Orthopedic Surgery, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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14
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Ushirozako H, Hasegawa T, Yamato Y, Yoshida G, Yasuda T, Banno T, Arima H, Oe S, Mihara Y, Yamada T, Ide K, Watanabe Y, Nakai K, Imada T, Matsuyama Y. Does preoperative prognostic nutrition index predict surgical site infection after spine surgery? 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; 30:1765-1773. [PMID: 33037485 DOI: 10.1007/s00586-020-06622-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/25/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, little is known about the relationship between SSI and the PNI in patients after spine surgery. We aimed to determine independent predictors of SSI after spine surgery. METHODS We analyzed 1115 patients who underwent spine surgery (369 males, 746 females, mean age 56 years, follow-up period: at least 1 year). Patients were divided into SSI and non-SSI groups. Preoperative risk factors, including PNI (10 × serum albumin [g/dL] + 0.005 × total lymphocyte count [/μL]), were assessed. RESULTS Postoperatively, 43 patients (3.9%) experienced SSI. Univariate analysis showed that preoperative PNI (48.5 vs 51.7; p < 0.01), revision status (p < 0.05), male sex (p < 0.01), body mass index (BMI) (p < 0.05), and usage of anticoagulant agents (p < 0.05) differed significantly between the SSI and non-SSI groups. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.90-0.98; p < 0.01), male sex (OR, 2.64; 95% CI: 1.40-4.99; p < 0.01), length of surgery ≥ 180 min (OR, 2.78; 95% CI: 1.30-5.96; p < 0.01), BMI ≥ 30 kg/m2 (OR, 2.89; 95% CI: 1.20-6.97; p < 0.05), and revision status (OR, 2.30; 95% CI: 1.07-4.98; p < 0.05) were independently associated with SSI postoperatively. CONCLUSION Lower preoperative PNI was found to be a risk factor for SSI after spine surgery. Patients with lower preoperative PNI values should be cautioned about the risk of SSI and provide adequate informed consent.
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Affiliation(s)
- Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tatsuya Yasuda
- Department of Orthopaedic Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shin Oe
- Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Keichi Nakai
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takaaki Imada
- Department of Orthopaedic Surgery, Omaezaki Municipal Hospital, Omaezaki, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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15
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Lee D, Lee R, Cross MT, Iweala U, Weinreb JH, Falk DP, O'Brien JR, Yu W. Risk Factors for Postoperative Urinary Tract Infections Following Anterior Lumbar Interbody Fusion. Int J Spine Surg 2020; 14:493-501. [PMID: 32986569 DOI: 10.14444/7065] [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] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although risk factors contributing to UTI have been studied in posterior approaches to lumbar fusion, there is a lack of literature on factors contributing to UTI in anterior lumbar interbody fusion (ALIF). Our purpose was to identify preoperative independent risk factors for postoperative urinary tract infection (UTI) following anterior lumbar interbody fusion (ALIF) so that surgeons may be able to initiate preventative measures and minimize the risk of UTI-related morbidity following ALIF. METHODS The American College of Surgeons-National Surgical Quality Improvement Program database was queried to identify 10 232 patients who had undergone ALIF from 2005 to 2016; 144 patients (1.41%) developed a postoperative UTI while 10 088 patients (98.59%) did not. Univariate analyses were conducted to compare the 2 cohorts' demographics and preoperative comorbidities. Multivariate logistic regression models were then utilized to identify significant predictors of postoperative UTI following ALIF while controlling for differences seen in univariate analyses. RESULTS Age ≥ 60 years (P = .022), female sex (P < .001), alcohol use (P = .014), open wound or wound infections (P = .019), and steroid use (P = .046) were independent risk factors for postoperative UTI. Longer operative times were also independent predictors for developing UTI: 120 minutes ≤ x < 180 minutes (P = .050), 180 minutes ≤ x < 240 minutes (P = .025), and ≥ 240 minutes (P = .001). Postoperative UTI independently increased the risk for pneumonia, blood transfusions, sepsis, thromboembolic events, and extended length of stay as well. CONCLUSIONS Age ≥ 60 years, female sex, alcohol use, steroid use, and open wound or wound infections independently increased the risk for UTI following ALIF. Future work analyzing the efficacy of tapering alcohol and steroid use preoperatively and reducing procedural time with the aim of lowering UTI risk is warranted. Preoperative wound care is strongly encouraged to decrease UTI risk. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Danny Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Megan T Cross
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Uchechi Iweala
- Department of Orthopaedic Surgery, The George Washington University, Washington, D.C
| | - Jeffrey H Weinreb
- Department of Orthopaedic Surgery, The George Washington University, Washington, D.C
| | - David P Falk
- Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph R O'Brien
- Washington Spine and Scoliosis Clinic, OrthoBethesda, Bethesda, Maryland
| | - Warren Yu
- Department of Orthopaedic Surgery, The George Washington University, Washington, D.C
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16
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Fernandez-Gerlinger MP, Arvieu R, Lebeaux D, Rouis K, Guigui P, Mainardi JL, Bouyer B. Successful 6-Week Antibiotic Treatment for Early Surgical-site Infections in Spinal Surgery. Clin Infect Dis 2020; 68:1856-1861. [PMID: 30247513 DOI: 10.1093/cid/ciy805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The incidence of spinal surgical site infections (SSIs) remains stable at less than 10%. Surgical reinterventions may be hampered by decubitus, treatment-related adverse events, and cost. In the context of emergence of bacterial resistance, a short duration of antimicrobial treatment is of critical importance. If the duration of treatment for SSI is currently 12 weeks, the aim of our study was to assess the efficacy of an antimicrobial treatment shortened to 6 weeks. METHODS This prospective study was carried out from November 2014 to July 2016 in an 827-bed teaching hospital. After surgical management of SSIs, patients received broad-spectrum antibiotics intravenously for 10 days and orally for the remainder, for a total of 6 weeks. Success was defined as absence of relapse, superinfection, or surgical failure at the end of treatment and at 1-year follow-up. RESULTS Eighty-five patients were included in this study. The median delay between initial surgery and diagnosis of SSI was 16 days. In 65 cases (76.4%), SSIs were monomicrobial; among these, Staphylococcus aureus was found in 30 cases (46%). Failure was observed in 7 cases (8.2%), with more than half caused by anaerobic bacteria. CONCLUSIONS Surgical management of SSI followed by a 6-week antibiotic treatment is associated with favorable outcome. Anaerobic bacteria seem to play a role in the occurrence of relapses. A 6-week reduction in antibiotic treatment leads to reduction in cost and, likely, also to reduction in the emergence and spread of resistant microorganisms.
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Affiliation(s)
- Marie-Paule Fernandez-Gerlinger
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Robin Arvieu
- Service d'Orthopédie et de Traumatologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - David Lebeaux
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Karama Rouis
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Pierre Guigui
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service d'Orthopédie et de Traumatologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Jean-Luc Mainardi
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Benjamin Bouyer
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service d'Orthopédie et de Traumatologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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17
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Agarwal A, Kelkar A, Agarwal AG, Jayaswal D, Schultz C, Jayaswal A, Goel VK, Agarwal AK, Gidvani S. Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery. Global Spine J 2020; 10:640-646. [PMID: 32677561 PMCID: PMC7359681 DOI: 10.1177/2192568219869330] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN A literature review. OBJECTIVE To summarize the implant removal rate, common bacterial organisms found, time of onset, ratio of superficial to deep infection, and regurgitating the prevalence among all the retrospective and prospective studies on management and characterization of surgical site infections (SSIs). METHODS PubMed was searched for articles published between 2000 and 2018 on the management or characterization of SSIs after spinal surgery. Only prospective and retrospective studies were included. RESULTS A total of 49 articles were found relevant to the objective. These studies highlighted the importance of implant removal to avoid recurrence of SSI. The common organisms detected were methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermis, Staphylococcus epidermis, Staphylococcus aureus, and Propionibacterium acnes, with prevalence of 1% to 15%. A major proportion of all were deep SSI, with minority reporting on late-onset SSI. CONCLUSION Long-term antibiotics administration, and continuous irrigation and debridement were common suggestion among the authors; however, the key measure undertaken or implied by most authors to avoid risk of recurrence was removal or replacement of implants for late-onset SSI.
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Affiliation(s)
- Aakash Agarwal
- University of Toledo, Toledo, OH, USA,Aakash Agarwal, Department of Bioengineering and Orthopaedics Surgery, University of Toledo, 5051 Nitschke Hall, MS 303, 2801 West Bancroft Street, Toledo, OH 43606, USA.
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18
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Knight BA, Bayne AP, Zusman N, Barney N, Yang S. Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2020; 8:703-709. [PMID: 32077085 DOI: 10.1007/s43390-020-00090-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study investigates postoperative urinary retention (POUR) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and the effects of postoperative analgesia and mobility on retention. High opioid use and decreased postoperative mobility are proposed risk factors for retention in adults. There is a paucity of literature on POUR in the adolescent population undergoing surgery for AIS. The impact of pain control and mobility on POUR in these patients is unknown. METHODS A retrospective cohort study was conducted of adolescents (11-18 years) undergoing elective PSF for AIS at a single institution (2012-2018). POUR was defined as the inability to void > 8 h after catheter removal. Possible risk factors for retention including opioid usage and ambulatory status at the time of catheter removal were assessed on univariate and binomial logistic regression analyses. RESULTS One hundred and thirty-six patients were included, with 21 (15.4%) experiencing POUR. On the day of catheter removal, 24 patients had not attempted ambulation; these patients had 2.5 times higher rate of POUR than those who were walking (30% vs. 12%, p = 0.04). Patients who developed retention ambulated a mean threefold shorter distance than those without POUR (45 vs. 136 feet, p = 0.04). On binomial logistic regression, decreased ambulation distance was associated with retention (p = 0.038). While opioid use was not significant on univariate analysis, higher opioid use on the day of catheter removal predicted retention on logistic regression (p = 0.001). POUR resolved in all patients (median duration 0.5 days, range 0-12 days). CONCLUSIONS The development of POUR after PSF for AIS affects one in six patients but resolves quickly. Non-ambulatory patients and patients who received large doses of opioids on the day of catheter removal were more likely to develop POUR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- B Alexander Knight
- Department of Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
| | - Aaron P Bayne
- Department of Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
| | - Natalie Zusman
- Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA
| | - Nicole Barney
- Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA
| | - Scott Yang
- Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA.
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Fujita R, Takahata M, Kokabu T, Oda I, Kajino T, Hisada Y, Takeuchi H, Iwasaki N. Retrospective study to evaluate the clinical significance of a second rise in C-reactive protein level following instrumented spinal fusion surgery. J Orthop Sci 2019; 24:963-968. [PMID: 31551179 DOI: 10.1016/j.jos.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/15/2019] [Accepted: 09/02/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This study aimed to identify the incidence and causes of a second rise in C-reactive protein (CRP) levels following spinal instrumentation surgery and to help determine how an abnormal CRP response should be interpreted and managed during postoperative care. METHODS The medical records of 948 patients who underwent instrumented spine fusion surgery and met the inclusion criteria were retrospectively reviewed to assess the frequency and causes of a second rise (SR) of CRP. A SR of CRP was defined when the CRP level after postoperative day 7 increased by more than 0.5 mg/dl from that at the previous time-point. The diagnostic cut-off value of CRP elevation for detection of surgical site infection (SSI) was determined. Cut-off values were analyzed using receiver operating characteristic (ROC) curves. Bayes' theorem was used to determine blood test posterior probabilities for SSI-positive cases using cutoff values of re-evaluated CRP levels. RESULTS SR of CRP occurred in 107 of the 948 patients. Of the patients with SR of CRP, 38 (35%) patients had developed SSI, 33 (31%) patients had causes other than SSI, and the remaining 36 patients had unidentified causes. Among the patients with SR, excluding those with causes other than SSI, the best diagnostic cut-off value of SR for detection of SSI was 3.04 mg/dl (area under the curve was 0.74). The posterior test probability was 84.4%. CONCLUSIONS For patients with SR of CRP, who had no causes other than SSI, an SR value of 3.04 mg/dl correlated with a high probability of developing SSI.
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Affiliation(s)
- Ryo Fujita
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Terufumi Kokabu
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Itaru Oda
- Hokkaido Orthopedic Memorial Hospital, Sapporo, Japan
| | | | - Yuichiro Hisada
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | | | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Li Z, Liu P, Zhang C, Xu G, Zhang Y, Chang Y, Liu M, Hou S. Incidence, Prevalence, and Analysis of Risk Factors for Surgical Site Infection After Lumbar Fusion Surgery: ≥2-Year Follow-Up Retrospective Study. World Neurosurg 2019; 131:e460-e467. [DOI: 10.1016/j.wneu.2019.07.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 11/24/2022]
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Mackenzie WGS, McLeod L, Wang K, Crotty J, Hope JE, Imahiyerobo TA, Ko RR, Anderson RCE, Saiman L, Vitale MG. Team Approach: Preventing Surgical Site Infections in Pediatric Scoliosis Surgery. JBJS Rev 2019; 6:e2. [PMID: 29406434 DOI: 10.2106/jbjs.rvw.16.00121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- W G Stuart Mackenzie
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Lisa McLeod
- Children's Hospital Colorado, Aurora, Colorado
| | - Kevin Wang
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Jennifer Crotty
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Jennifer E Hope
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Thomas A Imahiyerobo
- Division of Plastic Surgery, Department of Surgery (T.A.I.), Division of Pediatric Infectious Diseases, Department of Pediatrics (L.S.), and Department of Infection Prevention and Control (L.S.), New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Riva R Ko
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Richard C E Anderson
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
| | - Lisa Saiman
- Division of Plastic Surgery, Department of Surgery (T.A.I.), Division of Pediatric Infectious Diseases, Department of Pediatrics (L.S.), and Department of Infection Prevention and Control (L.S.), New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Michael G Vitale
- Departments of Orthopaedic Surgery (W.G.S.M., K.W., J.C., J.E.H., and M.G.V.), Anesthesiology (R.R.K.), and Neurological Surgery (R.C.E.A.), Columbia University Medical Center, New York, NY
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Is There a “Sex Effect” in 30-Day Outcomes After Elective Posterior Lumbar Fusions? World Neurosurg 2018; 120:e428-e433. [DOI: 10.1016/j.wneu.2018.08.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
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What are the risk factors for surgical site infection after spinal fusion? A 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 2018; 27:2469-2480. [DOI: 10.1007/s00586-018-5733-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/19/2018] [Accepted: 08/13/2018] [Indexed: 01/05/2023]
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Wang H, Zhang Z, Qiu G, Zhang J, Shen J. Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study. BMC Musculoskelet Disord 2018; 19:242. [PMID: 30025521 PMCID: PMC6053713 DOI: 10.1186/s12891-018-2148-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/20/2018] [Indexed: 12/17/2022] Open
Abstract
Backgrounds Rare study has been conducted to detect risk factors of perioperative complications, which are closely related to preoperative status of the patients and surgical stress. The aim of this study is to detect these relationships in degenerative scoliosis (DS) patients. Methods Perioperative complications of 226 cases with DS (56 males and 170 females; 65.5 ± 8.1 years old), who accepted posterior fusion in our hospital from January, 2013 to July, 2017, were retrospectively reviewed. Potential risk factors were first compared between patients with or without perioperative complications using student t test or Chi-squared test. Then, the unevenly distributed variables between the two groups were analyzed with binary logistic regression model. Results All patients separately underwent decompression with short limited instrumentation (116, 51.3%) or with long instrumentation for correction (110, 48.7%). The mean operation duration (OD) was 216.9 ± 64.2 min and the average amount of bleeding was 587.4 ± 357.2 ml. 44 cases (19.5%)suffered from the complications during the perioperative phase, including incision complications (5.3%), urinary infection (3.5%), dura tears/cerebrospinal fluid (CSF) leakages (3.5%) and new neurological deficits (2.7%). Hospital stay was significantly extended for the complications (p < 0.001). Univariate analysis showed that OD (p < 0.001), bleeding (p = 0.014), American Standards Association (ASA) grade > 2 (p = 0.011) and RBC transfusion≥4 U(p = 0.028) were associated with these complications. Multivariate logistic regressions revealed that only ASA grade > 2(p = 0.011, Odds Ratio[OR] = 4.104, 95% Confidence Interval[CI] = 1.413~ 11.917) and OD (p = 0.013, OR = 2.697, 95% CI = 1.233~ 5.899) were the independent risk factors. Conclusions The high morbidity of perioperative complications for posterior spinal fusion would significantly extend hospital stay of DS patients. It was independently related to higher ASA grade and longer OD.
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Affiliation(s)
- Hai Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Zheping Zhang
- Department of Orthopaedic Surgery, Beijing Puren Hospital, Beijing, China
| | - Guixing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Jianguo Zhang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing, 100730, China.
| | - Jianxiong Shen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing, 100730, China.
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25
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Development of Consensus-Based Best Practice Guidelines for Postoperative Care Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2017; 42:E547-E554. [PMID: 28441684 DOI: 10.1097/brs.0000000000001865] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Delphi process with multiple iterative rounds using a nominal group technique. OBJECTIVE The aim of this study was to use expert opinion to achieve consensus on various aspects of postoperative care following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Significant variability exists in postoperative care following PSF for AIS, despite a relatively healthy patient population and continuously improving operative techniques. Current practice appears based either on lesser quality studies or the perpetuation of long-standing protocols. METHODS An expert panel composed of 26 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting (one electronic and two face-to-face). Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. RESULTS Consensus was reached to support 19 best practice guideline (BPG) measures for postoperative care addressing non-ICU admission, perioperative pain control, dietary management, physical therapy, postoperative radiographs, surgical bandage management, and indications for discharge. CONCLUSION We present a consensus-based BPG consisting of 19 recommendations for the postoperative management of patients following PSF for AIS. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research. LEVEL OF EVIDENCE 5.
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26
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Patel H, Khoury H, Girgenti D, Welner S, Yu H. Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement of Staphylococcus aureus. Surg Infect (Larchmt) 2016; 18:461-473. [PMID: 27901415 PMCID: PMC5466015 DOI: 10.1089/sur.2016.186] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs. METHODS PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations. RESULTS Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%-22.6%) and 1.0% (median, 2.0%; range, 0.02%-10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%-100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%-100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%-2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%-100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI. CONCLUSIONS Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.
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Affiliation(s)
| | | | | | | | - Holly Yu
- Pfizer Inc., Collegeville, Pennsylvania
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27
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Risk factors for surgical site infection and urinary tract infection after spine surgery. 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 2016; 25:3908-3915. [DOI: 10.1007/s00586-016-4674-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/16/2016] [Accepted: 06/18/2016] [Indexed: 11/25/2022]
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Pokrzywa CJ, Papageorge CM, Kennedy GD. Preoperative urinary tract infection increases postoperative morbidity. J Surg Res 2016; 205:213-20. [PMID: 27621022 DOI: 10.1016/j.jss.2016.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/23/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preoperative urinary tract infection (UTI) may be associated with surgical site infections secondary to hematogenous spread of bacteria. The association between preoperative UTI and postoperative complications has not been evaluated in general surgery populations. MATERIALS AND METHODS Patients undergoing elective general surgery procedures from 2011 to 2013 were selected from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with UTI present at the time of surgery (PATOS) were identified as cases. Patients without UTI PATOS were selected and matched 2:1 on age, American Society of Anesthesiologists class, and Current Procedural Terminology code with identified cases. Univariate and multivariate analyses compared postoperative outcomes between the two groups. RESULTS A total of 434,802 patients were identified for inclusion in the study, with an overall preoperative UTI rate of 0.1% (n = 363). On univariate analysis, the UTI group had a significantly higher incidence of overall complications, infectious complications, and noninfectious complications. Multivariate analysis confirmed that patients with UTI had a higher risk of postoperative complications compared with those without preoperative UTI (odds ratio [OR] 1.551, 95% confidence interval [CI] 1.071-2.247). This relationship persisted for both infectious (OR 1.515, 95% CI 1.000-2.296) and noninfectious (OR 1.683, 95% CI 1.012-2.799) complications. CONCLUSIONS We demonstrated an increased rate of 30-d complications in elective general surgery patients with UTI PATOS. These findings suggest that diligent efforts to diagnose and treat UTI before surgery may result in improved outcomes. Furthermore, surgeons should consider postponing elective procedures to allow for the complete resolution of preoperative UTI.
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Affiliation(s)
- Courtney J Pokrzywa
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christina M Papageorge
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Chew R, Woods ML. Decompressive Laminectomy Complicated by Postoperative Mycoplasma hominis Epidural Abscess and Meningitis in a Young Woman: A Case Report. JBJS Case Connect 2016; 6:e25. [PMID: 29252619 DOI: 10.2106/jbjs.cc.o.00139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A twenty-eight-year-old woman underwent decompressive laminectomy and placement of an interlaminar stabilizer due to L4/L5 disc herniation. Thirteen days later she developed a fever unresponsive to meropenem and vancomycin, along with signs of meningitis. A Mycoplasma hominis epidural abscess was identified. She had no preoperative risk factors for extragenital M. hominis infection, but had had a urinary catheter inserted intraoperatively. CONCLUSION M. hominis postoperative surgical site infection is a rarely identified complication of spinal surgery. Seeding from the genitourinary tract is the most likely source.
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Affiliation(s)
- Rusheng Chew
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Parker SL, McGirt MJ, Bekelis K, Holland CM, Davies J, Devin CJ, Atkins T, Knightly J, Groman R, Zyung I, Asher AL. The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale. Neurosurg Focus 2015; 39:E4. [DOI: 10.3171/2015.9.focus15355] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meaningful quality measurement and public reporting have the potential to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. Recent developments in national quality reporting programs, such as the Centers for Medicare & Medicaid Services Qualified Clinical Data Registry (QCDR) reporting option, have enhanced the ability of specialty groups to develop relevant quality measures of the care they deliver. QCDRs will complete the collection and submission of Physician Quality Reporting System (PQRS) quality measures data on behalf of individual eligible professionals. The National Neurosurgery Quality and Outcomes Database (N2QOD) offers 21 non-PQRS measures, initially focused on spine procedures, which are the first specialty-specific measures for neurosurgery. Securing QCDR status for N2QOD is a tremendously important accomplishment for our specialty. This program will ensure that data collected through our registries and used for PQRS is meaningful for neurosurgeons, related spine care practitioners, their patients, and other stakeholders. The 2015 N2QOD QCDR is further evidence of neurosurgery’s commitment to substantively advancing the health care quality paradigm. The following manuscript outlines the measures now approved for use in the 2015 N2QOD QCDR. Measure specifications (measure type and descriptions, related measures, if any, as well as relevant National Quality Strategy domain[s]) along with rationale are provided for each measure.
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Affiliation(s)
| | - Matthew J. McGirt
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Kimon Bekelis
- 3Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Jason Davies
- 5Department of Neurological Surgery, State University of New York at Buffalo, New York
| | - Clinton J. Devin
- 6Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler Atkins
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Jack Knightly
- 7Department of Neurological Surgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Rachel Groman
- 8Clinical Affairs and Quality Improvement, Hart Health Strategies, Washington, DC; and
| | - Irene Zyung
- 9American Association of Neurological Surgeons, Rolling Meadows, Illinois
| | - Anthony L. Asher
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
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Risk factors for surgical site infections following spinal surgery. J Clin Neurosci 2015; 22:1862-6. [DOI: 10.1016/j.jocn.2015.03.065] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/16/2015] [Accepted: 03/21/2015] [Indexed: 01/11/2023]
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