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Risk Factors for Surgical Site Infections Following Adult Spine Operations

Published online by Cambridge University Press:  30 August 2016

Ambar Haleem ,
Hsiu-Yin Chiang ,
Ravindhar Vodela ,
Andrew Behan ,
Jean M. Pottinger ,
Joseph Smucker ,
Jeremy D. Greenlee ,
Charles Clark  and
Loreen A. Herwaldt
Ambar Haleem
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Hsiu-Yin Chiang
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Ravindhar Vodela
Affiliation:
Mercy Health West Hospital, Cincinnati, Ohio
Andrew Behan
Affiliation:
Mercy Health Lourdes Hospital, Paducah, Kentucky
Jean M. Pottinger
Affiliation:
Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Joseph Smucker
Affiliation:
Indiana Spine Group, Carmel Facility, Carmel, Indiana
Jeremy D. Greenlee
Affiliation:
Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
Charles Clark
Affiliation:
Department of Orthopaedics, University of Iowa Carver College of Medicine, Iowa City, Iowa
Loreen A. Herwaldt*
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
*
Address correspondence to Loreen A. Herwaldt, MD, Department of Internal Medicine, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1081 ([email protected]).
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Abstract

OBJECTIVE

To identify risk factors for surgical site infections (SSIs) after spine operations.

DESIGN

Case-control study of SSIs among patients undergoing spine operations.

SETTING

An academic health center.

PATIENTS

We studied patients undergoing spinal fusions or laminectomies at the University of Iowa Hospitals and Clinics from January 1, 2007, through June 30, 2009. We included patients who acquired SSIs meeting the National Healthcare Safety Network definition. We randomly selected controls among patients who had spine operations during the study period and did not meet the SSI definition.

RESULTS

In total, 54 patients acquired SSIs after 2,309 spine operations (2.3 per 100 procedures). SSIs were identified a median of 20 days after spinal fusions and 17 days after laminectomies; 90.7% were identified after discharge and 72.2% were deep incisional or organ-space infections. Staphylococcus aureus caused 53.7% of SSIs. Of patients with SSIs, 64.9% (fusion) and 70.6% (laminectomy) were readmitted and 59.5% (fusion) and 64.7% (laminectomy) underwent reoperation. By multivariable analysis, increased body mass index, Surgical Department A, fusion of 4–8 vertebrae, and operation at a thoracic or lumbar/sacral level were significant risk factors for SSIs after spinal fusions. Lack of private insurance and hypertension were significant risk factors for SSIs after laminectomies. Surgeons from Department A were more likely to use nafcillin or vancomycin for perioperative prophylaxis and to do more multilevel fusions than surgeons from Department B.

CONCLUSIONS

SSIs after spine operations significantly increase utilization of healthcare resources. Possible remediable risk factors include obesity, hypertension, and perioperative antimicrobial prophylaxis.

Infect Control Hosp Epidemiol 2016;1458–1467

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1458 - 1467
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. We presented part of this study during the 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA) in Dallas, Texas, April 1–4, 2011.

References

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