Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T20:24:31.013Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Spinal Surgical-Site Infections in a Community Hospital: A Case–Control Study

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak ,
Marilyn Jones ,
Brian M. Waterman ,
Cathy M. Carroll ,
Robert Bernardi  and
Victoria J. Fraser
Anucha Apisarnthanarak
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marilyn Jones
Affiliation:
Infection Control Department, BJC Health Care System, St. Louis, Missouri
Brian M. Waterman
Affiliation:
Infection Control Department, BJC Health Care System, St. Louis, Missouri
Cathy M. Carroll
Affiliation:
Infection Control Department, BJC Health Care System, St. Louis, Missouri
Robert Bernardi
Affiliation:
Neurosurgery Division, BJC Health Care System, St. Louis, Missouri
Victoria J. Fraser*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Ave., St. Louis, MO 63110
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To characterize risk factors for surgical-site infection after spinal surgery.

Design:

A case–control study.

Setting:

A 113-bed community hospital.

Method:

From January 1998 through June 2000, the incidence of surgical-site infection in patients undergoing laminectomy, spinal fusion surgery, or both increased at community hospital. A We compared 13 patients who acquired surgical-site infections after laminectomy, spinal fusion surgery, or both with 47 patients who were operated on during the same time period but did not acquire a surgical-site infection. Information collected included demographics, risk factors, personnel involved in the operations, length of hospital stay, and hospital costs.

Results:

Of 13 case-patients, 9 (69%) were obese, 9 (69%) had spinal compression, 5 (38.5%) had a history of tobacco use, and 4 (31%) had diabetes. Oxacillin-sensitive Staphylococcus aureus (6 of 13; 46%) was the most common organism isolated. Significant risk factors for postoperative spinal surgical-site infection were dural tear during the surgical procedure and the use of glue to cement the dural patch (3 of 13 [23%] vs 1 of 47 [2.1%] ; P = .02) and American Society of Anesthesiologists risk class of 3 or more (6 of 13 [46.2%] vs 7 of 47 [15%]; P = .02). Case-patients were more likely to have prolonged length of stay (median, 16 vs 4 days; P < .001). The average excess length of stay was 11 days and the excess cost per case was $12,477.

Conclusion:

Dural tear and the use of glue should be evaluated as potential risk factors for spinal surgical-site infection. Systematic observation for potential lapses in sterile technique and surgical processes that may increase the risk of infection may help prevent spinal surgical-site infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 31 - 36
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

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

References

1.Stambough, JL, Beringer, D. Postoperative wound infections complicating adult spine surgery. J Spinal Disord 1992;5:277–285.Google Scholar
2.Knapp, Dr Jr, Jones, ET. Use of cortical cancellous allograft for posterior spinal fusion. Clin Orthop 1988;229:99–106.CrossRefGoogle Scholar
3.Horwitz, NH, Curtin, JA. Prophylactic antibiotics and wound infections following laminectomy for lumbar disc herniation: a retrospective study. J Neurosurg 1975;43:727–731.Google Scholar
4.Lonstein, JE, Akbarnia, A. Operative treatment of spinal deformities in patients with cerebral palsy or mental retardation: an analysis of one hundred and seven cases. J Bone Joint Surg Am 1983;65:43–55.Google Scholar
5.Polk, HC Jr, Simpson, CJ, Simmons, BP, Alexander, JW. Guidelines for prevention of surgical wound infection. Arch Surg 1983;118:1213–1217.CrossRefGoogle ScholarPubMed
6.Cronquist, AB, Jakob, K, Lai, L, Della Latta, P, Larson, EL. Relationship between skin microbial counts and surgical site infection after neuro-surgery. Clin Infect Dis 2001;33:1302–1308.Google Scholar
7.Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Toison, JS. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33(suppl 2):S69–S77.Google Scholar
8.Ozuna, RM, Delamarter, RB. Pyogenic vertebral osteomyelitis and post-surgical disc space infections. Orthop Clin North Am 1996;27:87–94.Google Scholar
9.Polk, HC Jr. Principles of preoperative preparation of the surgical patient. In: Sabiston, DC, ed. Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Philadelphia: W. B. Saunders; 1986:87–98.Google Scholar
10.Capen, DA, Calderone, RR, Green, A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am 1996;27:83–86.Google Scholar
11.Cruse, PJ, Foord, R. A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206–210.Google Scholar
12.Kemp, HB, Jackson, JW, Jeremiah, JD, Cook, J. Anterior fusion of the spine for infective lesions in adults. J Bone Joint Surg Br 1973;55:715–734.CrossRefGoogle ScholarPubMed
13.Lindholm, TS, Pylkkanen, P. Discitis following removal of intervertebral disc. Spine 1982;7:618–622.Google Scholar
14.Picada, R, Winter, RB, Lonstein, JE, et al. Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 2000;13:42–45.Google Scholar
15.Wimmer, C, Gluch, H, Franzreb, M, Ogon, M. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 1998;11:124–128.Google Scholar
16.Kramer, MH, Mangram, AJ, Pearson, ML, Jarvis, WR. Surgical-site complications associated with a morphine nerve paste used for postoperative pain control after laminectomy. Infect Control Hosp Epidemiol 1999;20:183–186.Google Scholar
17.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions for nosocomial infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271–274.Google Scholar
18.Isenberg, H. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1994.Google Scholar
19.New classification of physical status. Anesthesiology 1963;24:107–111.Google Scholar
20.Owens, WD. ASA physical status classification: a study on consistency of ratings. Anesthesiology 1978;49:239–243.Google Scholar
21.Keats, AS. The ASA classification of physical status: a recapitulation. Anesthesiology 1978;49:233–236.Google Scholar
22.Mathias, JM. CDC updates guideline on surgical site infection. OR Manager 1998;14:9–10.Google Scholar
23.Patir, R, Mahapatra, AK, Benerji, AK. Risk factors in postoperative neuro-surgical infection: a prospective study. Acta Neurochir (Wien) 1992;119:80–84.Google Scholar
24.Weinstein, MA, McCabe, JP, Cammisa, FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 2000;13:422–426.Google Scholar
25.Dougherty, SH, Simmons, RL. The biology and practice of surgical drains: part II. Curr Probi Surg 1992;29:633–730.Google Scholar
26.McPhee, IB, Williams, RP, Swanson, CE. Factors influencing wound healing after surgery for metastatic disease of the spine. Spine 1998;23:726–733.Google Scholar
27.Eismont, FJ, Bohlman, HH, Soni, PL, Goldberg, VM, Freehafer, AA. Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg Am 1983;65:19–29.Google Scholar
28.Wood, GW. Spinal infections. Spine State of Art Reviews 1989;3:385–494.Google Scholar
29.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.Google Scholar
30.Martone, WJ, Nichols, RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis 2001;33(suppl 2):S67–S68.Google Scholar
31.Department of Health and Human Services, Health Care Financing Administration. Medicare program: prospective payments for Medicare inpatient hospital services, interim final rule with comment period. Federal Register 39752 (1983).Google Scholar
32.Department of Health and Human Services, Health Care Financing Administration. Medicare program: prospective payment for Medicare inpatient hospital services, final rule. Federal Register 234 (1984).Google Scholar
33.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.Google Scholar
34.Haley, RW, White, JW, Culver, DH, Hughes, JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system: an empirical determination from a nationally representative sample. JAMA 1987;257:1611–1614.Google Scholar