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Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study

Published online by Cambridge University Press:  19 December 2016

Thomas L. Walsh ,
Ashley M. Querry ,
Sheila McCool ,
Alison L. Galdys ,
Kathleen A. Shutt ,
Melissa I. Saul  and
Carlene A. Muto
Thomas L. Walsh*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Ashley M. Querry
Affiliation:
Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Sheila McCool
Affiliation:
Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Alison L. Galdys
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Kathleen A. Shutt
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
Melissa I. Saul
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Carlene A. Muto
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
*
Address correspondence to Thomas L. Walsh, MD, Division of Infectious Diseases, Allegheny General Hospital, 320 East North Avenue, 4th Floor East Wing, Suite 406, Pittsburgh, PA 15136 ([email protected]).
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Abstract

OBJECTIVE

To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion.

DESIGN

Retrospective case-control study.

SETTING

Large, academic, quaternary care center.

PATIENTS

The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI.

METHODS

To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls.

RESULTS

During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78).

CONCLUSIONS

In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion.

Infect Control Hosp Epidemiol 2017;38:348–352

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 340 - 347
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Hall, MJ, DeFrances, CJ, Williams, SN, Golosinskiy, A, Schwartzman, A. National hospital discharge survey: 2007 summary. Natl Health Stat Report 2010;29:1–20.Google Scholar
2. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470.Google Scholar
3. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
4. Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Tolson, JS, National Nosocomial Infections Surveillance System. 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:s69–s77.Google Scholar
5. Healthcare Cost and Utilization Project: Statistics on hospital stays, 2013. Agency for Healthcare Research and Quality website. http://hcupnet.ahrq.gov/. Published 2013. Accessed August 2, 2016.Google Scholar
6. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection. Am J Infect Control 1999;27:97–134.Google Scholar
7. Herwaldt, LA, Cullen, JJ, Scholz, , et al. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol 2006;27:1291–1298.CrossRefGoogle ScholarPubMed
8. de Lissovoy, G, Fraeman, K, Hutchins, V, et al. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387–397.Google Scholar
9. Massie, JB, Heller, JG, Abitbol, JJ, McPherson, D, Garfin, SR. Postoperative posterior spinal wound infections. Clin Orthop Relat Res 1992;284:99–108.Google Scholar
10. Rao, SB, Vasquez, G, Harrop, J, et al. Risk factors for surgical site infection following spinal fusion procedures: a case-control study. Clin Infect Dis 2011;53:686–692.Google Scholar
11. Koutsoumbelis, S, Hughes, AP, Girardi, FP, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am 2011;93:1627–1633.CrossRefGoogle ScholarPubMed
12. Olsen, MA, Mayfield, J, Lauryssen, C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98:149–155.Google Scholar
13. Thomas, EJ, Goldman, L, Mangione, CM, et al. Body mass index as a correlate of postoperative complications and resource utilization. Am J Med 1997;102:277–283.CrossRefGoogle ScholarPubMed
14. Patel, N, Bagan, B, Vadera, S, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 2007;6:291–297.CrossRefGoogle ScholarPubMed
15. Peng, CW, Bendo, JA, Goldstein, JA, Nalbandian, MM. Perioperative outcomes of anterior lumbar surgery in obese versus non-obese patients. Spine J 2009;9:715–720.Google Scholar
16. Pull ter Gunne, AF, Cohen, DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976) 2009;34:1422–1428.CrossRefGoogle ScholarPubMed
17. Maragakis, LL, Cosgrove, SE, Martinez, EA, Tucker, MG, Cohen, DB, Perl, TM. Intraoperative fraction of inspired oxygen is a modifiable risk factor for surgical site infection after spinal surgery. Anesthesiology 2009;110:556–562.CrossRefGoogle ScholarPubMed
18. Olsen, MA, Nepple, JJ, Riew, DK, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008;90:62–69.Google Scholar
19. Veeravagu, A, Patil, CG, Lad, SP, Boakye, M. Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine 2009;34:1869–1872.Google Scholar
20. Browne, JA, Cook, C, Pietrobon, R, et al. Diabetes and early postoperative outcomes following lumbar fusion. Spine 2007;32:2214–2219.Google Scholar
21. Malone, DL, Genuit, T, Tracy, JK, et al. Surgical site infections: reanalysis of risk factors. J Surg Res 2002;103:89–95.Google Scholar
22. Hikata, M, Iwanami, A, Hosogane, N, et al. High preoperative hemoglobic A1C is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthopaed Sci 2014;19:223–228.Google Scholar
23. Friedman, ND, Sexton, DJ, Connelly, SM, et al. Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol 2007;28:1060–1065.CrossRefGoogle ScholarPubMed
24. Chen, S, Anderson, MV, Cheng, WK, et al. Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 2009;467:1670–1673.Google Scholar
25. Simpson, JM, Silveri, CP, Balderston, RA, Simeone, FA, An, HS. The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Joint Surg Am 1993;75:1823–1829.Google Scholar
26. Wilmmer, 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
27. Schimmel, JJP, Horsting, PP, de Kleuver, M, Wonders, G, van Limbeek, J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 2010;19:1711–1719.Google Scholar
28. Klein, JD, Hey, LA, Yu, CS, et al. Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine 1996;21:2676–2682.Google Scholar
29. Ahn, N, Klug, R, Nho, S, et al. Smoking, smoking cessation, and wound complications after lumbar spine surgery. Spine J 2002;2:113–114.Google Scholar
30. Fang, A, Hu, SS, Endres, N, et al. Risk factors for infection after spinal surgery. Spine 2005;30:1460–1465.CrossRefGoogle ScholarPubMed
31. Apisarnthanarak, A, Jones, M, Waterman, BM, et al. Risk factors for spinal surgical-site infections in a community hospital: a case-control study. Infect Control Hosp Epidemiol 2003;24:31–36.Google Scholar
32. Richards, BS, Herring, JA, Johnston, CE, et al. Treatment of adolescent idiopathic scoliosis using Texas Scottish Rite Hospital instrumentation. Spine 1994;19:1598–1605.Google Scholar
33. Weinstein, MA, McCabe, JP, Cammisa, FP Jr. Postoperative spinal wound infection: a review of 2391 consecutive index procedures. J Spinal Disord 2000;13:422–426.Google Scholar
34. Levi, AD, Dickman, CA, Sonntag, VK. Management of postoperative infections after spinal instrumentation. J Neurosurg 1997;86:975–980.CrossRefGoogle ScholarPubMed
35. Yount, RJ, Vries, JK, Coucill, CD. The medical archival retrieval system: an information retrieval system based on distributed parallel processing. Inf Proc Manag 1991;27:379–389.Google Scholar
36. ACH Surveillance for Surgical Site Infection Events. 2016. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/acute-care-hospital/ssi/. Published 2016. Accessed July 28, 2016.Google Scholar
37. Thakkar, V, Ghobrial, GM, Maulucci, CM, et al. Nasal MRSA colonization: impact on surgical site infection following spine surgery. Clin Neurol Neurosurg 2014;125:94–97.CrossRefGoogle ScholarPubMed
38. Kim, DH, Spencer, M, Davidson, SM, et al. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am 2010;92:1820–1826.CrossRefGoogle ScholarPubMed
39. Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus . N Engl J Med 2010;362:9–17.CrossRefGoogle ScholarPubMed
40. Kao, LS, Meeks, D, Moyer, VA, et al. Peri-operative glycaemic control regimens for preventing surgical site infections in adults. Cochrane Database Syst Rev 2009;8(3):CD006806.Google Scholar