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Risk Factors for Surgical Site Infection Complicating Laminectomy

Published online by Cambridge University Press:  02 January 2015

N. Deborah Friedman ,
Daniel J. Sexton ,
Sarah M. Connelly  and
Keith S. Kaye
N. Deborah Friedman*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Hospital, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Hospital, Durham, North Carolina
Sarah M. Connelly
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Hospital, Durham, North Carolina
Keith S. Kaye*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Hospital, Durham, North Carolina
*
International Training and Education Center on HIV, PO Box 20752, Windhoek, Namibia ([email protected])
Box 3152, DUMC, Durham, NC, 27710 ([email protected])
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Abstract

Objective.

To examine risk factors for surgical site infection (SSI) following spinal surgery and to analyze the associations between a surgeon's years of operating experience and surgical specialty and patients' SSI risk.

Design.

Case-control study.

Setting.

A tertiary care facility and a community hospital in Durham, North Carolina.

Patients.

Each case patient who developed an SSI complicating laminectomy was matched with 2 noninfected control patients by hospital, year of surgery, and National Nosocomial Infection Surveillance System risk index score.

Results.

Forty-one case patients with SSI complicating laminectomy and 82 matched control patients were analyzed. Nonwhite race, diabetes and an elevated body mass index (BMI) were more common among case patients than among control patients. Subjects with a BMI greater than 35 were more likely to undergo a prolonged procedure, compared with case patients who had a BMI of 35 or less. The SSI rate for patients operated on by neurosurgeons was 28%, compared with 43% for patients operated on by orthopedic surgeons (odds ratio [OR], 0.5; P = .12). The number of years of operating experience were not associated with SSI risk. Multivariate analysis revealed diabetes (OR, 4.2 [95% confidence interval {CI}, 1.1-16.3]; P = .04), BMI greater than 35 (OR, 7.1 [95% CI, 1.8-28.3]; P = .005), and laminectomy at a level other than cervical (OR, 6.7 [95% CI, 1.4-33.3]; P = .02) as independent risk factors for SSI following laminectomy.

Conclusion.

Diabetes, obesity, and laminectomy at a level other than cervical are independent risk factors for SSI following laminectomy. Preoperative weight loss and tight perioperative control of blood glucose levels may reduce the risk of SSI in laminectomy patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 9 , September 2007 , pp. 1060 - 1065
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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