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Liu H, Wang Y, Xing H, Chang Z, Pan J. Risk factors for deep surgical site infections following orthopedic trauma surgery: a meta-analysis and systematic review. J Orthop Surg Res 2024; 19:811. [PMID: 39614292 DOI: 10.1186/s13018-024-05299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 11/20/2024] [Indexed: 12/01/2024] Open
Abstract
OBJECTIVE We conducted this meta-analysis to explore the risk factors and incidence of deep surgical site infections (DSSIs) after orthopaedic trauma surgery. METHODS A systematic search was conducted across various databases, including MEDLINE, Embase, Cochrane Library, and Web of Science, for studies examining risk factors associated with DSSIs after bone trauma procedures. The search concluded on September 1, 2024. Data analysis was performed using Stata 15.0. RESULTS Among 2,722 publications screened, 16 studies that met the eligibility criteria were included in the analysis, involving a total of 22,318 patients, of whom 894 experienced DSSIs. The meta-analysis revealed a combined incidence of deep infections after orthopedic trauma surgery at [ES = 6.7%, 95% CI (5.1%-8.2%)]. Risk factors identified included male gender [OR = 1.99, 95% CI (1.39, 2.86), p < 0.0001], current smoking status [OR = 2.60, 95% CI (1.85, 3.65), p < 0.0001], open injuries [OR = 3.17, 95% CI (1.72, 5.85), p < 0.0001], a BMI greater than 26.0 kg/m2 [OR = 1.95, 95% CI (1.24, 3.07), p = 0.004], wound class ≥ 2 [OR = 2.40, 95% CI (1.56, 3.70), p < 0.0001], and a surgery duration of 60 min or more [OR = 2.41, 95% CI (1.63, 3.55), p < 0.0001]. These factors significantly contribute to the risk of developing DSSIs post-surgery. However, age did not exhibit a significant difference. CONCLUSION This study identifies key risk factors for DSSI following orthopedic trauma surgery, addressing a gap in the existing literature and offering some insights for clinical decision-making. To mitigate the risk of DSSI, clinical practice should encourage patients to lose weight and quit smoking prior to surgery, optimize surgical procedures, and improve wound management strategies. Future research should aim to standardize follow-up durations and further refine the classification of risk factors, in order to validate and expand on the conclusions of this study.
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Affiliation(s)
- Huan Liu
- Department of Orthopedics, The 960, Hospital of PLA, 25 Shifan Road, Tiangiao District, Jinan, 250031, Shandong, China
- School of Clinical Medicine, Shandong Second Medical University, Weifang, 261053, Shandong, China
| | - Yanan Wang
- Department of Orthopedics, The 960, Hospital of PLA, 25 Shifan Road, Tiangiao District, Jinan, 250031, Shandong, China
- School of Clinical Medicine, Shandong Second Medical University, Weifang, 261053, Shandong, China
| | - Hao Xing
- Department of Orthopedics, The 960, Hospital of PLA, 25 Shifan Road, Tiangiao District, Jinan, 250031, Shandong, China
| | - Zhengqi Chang
- Department of Orthopedics, The 960, Hospital of PLA, 25 Shifan Road, Tiangiao District, Jinan, 250031, Shandong, China.
| | - Junlin Pan
- Department of Reproductive Medicine, The 960, Hospital of PLA, 25 Shifan Road, Tiangiao District, Jinan, 250031, Shandong, China.
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Reissier S, Couzigou C, Courseau R, Aubert E, Le Monnier A, Bonnet E, Upex P, Moreau PE, Riouallon G, Lourtet-Hascoët J. Microbiological Profile of Instrumented Spinal Infections: 10-Year Study at a French Spine Center. Antibiotics (Basel) 2024; 13:791. [PMID: 39334966 PMCID: PMC11428694 DOI: 10.3390/antibiotics13090791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVE The objective was to compare the microbiological characteristics and treatment of early and late surgical site infections (SSIs) in instrumented spinal surgery. METHODS Those patients admitted for SSIs in a single center between January 2010 and December 2022 were included. The subjects were divided into early (eSSIs) and late (lSSIs) SSIs, and demographic, microbiological, treatment, and follow-up data were collected. RESULTS Instrumented spinal surgery was performed in 2136 patients. Ninety-six cases of infections were identified (prevalence = 4.5%), with 47.9% eSSIs and 52.1% lSSIs. In 58.7% of the cases, the eSSIs were monomicrobial: Staphylococcus aureus (37%) and Enterobacterales (33.3%) were the main bacteria involved. In 66% of the cases, the lSSIs, were monomicrobial: Cutibacterium acnes (30.3%) and staphylococci were predominant. Enterobacterales were isolated in more than 70% of the polymicrobial samples in both the eSSIs and lSSIs. The treatment of the eSSIs mostly consisted of lavage-debridement surgery associated with antibiotic treatment, while the treatment of the lSSIs combined hardware removal or replacement and long-duration antibiotic treatment. A negative outcome was observed in 17.1% of the eSSIs and 5.7% of the lSSIs. Enterobacterales were associated with negative outcomes of eSSIs. CONCLUSIONS Enterobacterales were found in most of the polymicrobial infections regardless of the time of infection onset. Further large studies should be conducted to precisely determine the management and prevention regarding the increasing Gram-negative bacteria SSIs.
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Affiliation(s)
- Sophie Reissier
- Laboratoire de Microbiologie Clinique et Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
- Laboratoire de Bactériologie-Hygiène Hospitalière, CHU de Rennes, 35033 Rennes, France
| | - Carine Couzigou
- Équipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Romain Courseau
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Elise Aubert
- Laboratoire de Microbiologie Clinique et Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Alban Le Monnier
- Laboratoire de Microbiologie Clinique et Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Eric Bonnet
- Équipe Mobile d'Infectiologie, Hôpital Joseph Ducuing, 31300 Toulouse, France
| | - Peter Upex
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Pierre-Emmanuel Moreau
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Julie Lourtet-Hascoët
- Laboratoire de Microbiologie Clinique et Plateforme de Dosage des Anti-Infectieux, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
- Équipe Mobile d'Infectiologie, Hôpital Joseph Ducuing, 31300 Toulouse, France
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Zhang Q, Chen G, Zhu Q, Liu Z, Li Y, Li R, Zhao T, Liu X, Zhu Y, Zhang Z, Li H. Construct validation of machine learning for accurately predicting the risk of postoperative surgical site infection following spine surgery. J Hosp Infect 2024; 146:232-241. [PMID: 38029857 DOI: 10.1016/j.jhin.2023.09.024] [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] [Received: 05/29/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the risk factors for machine learning (ML) algorithms in predicting postoperative surgical site infection (SSI) following spine surgery. METHODS This prospective cohort study included 986 patients who underwent spine surgery at Taizhou People's Hospital Affiliated to Nanjing Medical University from January 2015 to October 2022. Supervised ML algorithms included support vector machine, logistic regression, random forest, XGboost, decision tree, k-nearest neighbour, and naïve Bayes (NB), which were tested and trained to develop a predicting model. The ML model performance was evaluated from the test dataset. We gradually analysed their accuracy, sensitivity, and specificity, as well as the positive predictive value, negative predictive value, and area under the curve. RESULTS The rate of SSI was 9.33%. Using a backward stepwise approach, we identified that the remarkable risk factors predicting SSI in the multi-variate Cox regression analysis were age, body mass index, smoking, cerebrospinal fluid leakage, drain duration and pre-operative albumin level. Compared with other ML algorithms, the NB model had the highest performance in seven ML models, with an average area under the curve of 0.95, sensitivity of 0.78, specificity of 0.88, and accuracy of 0.87. CONCLUSIONS The NB model in the ML algorithm had excellent calibration and accurately predicted the risk of SSI compared with the existing models, and might serve as an important tool for the early detection and treatment of SSI following spinal infection.
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Affiliation(s)
- Q Zhang
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - G Chen
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - Q Zhu
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Z Liu
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Y Li
- Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - R Li
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - T Zhao
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Postgraduate School, Dalian Medical University, Dalian, People's Republic of China
| | - X Liu
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Y Zhu
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - Z Zhang
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China
| | - H Li
- Department of Orthopedics, Taizhou People's Hospital, Nanjing Medical University, Taizhou, People's Republic of China; Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, People's Republic of China.
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Adapa AR, Linzey JR, Moriguchi F, Daou BJ, Khalsa SSS, Ponnaluri-Wears S, Thompson BG, Park P, Pandey AS. Risk factors and morbidity associated with surgical site infection subtypes following adult neurosurgical procedures. Br J Neurosurg 2024; 38:503-509. [PMID: 33779461 DOI: 10.1080/02688697.2021.1905773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies on surgical site infection (SSI) in adult neurosurgery have presented all subtypes of SSIs as the general 'SSI'. Given that SSIs constitute a broad range of infections, we hypothesized that clinical outcomes and management vary based on SSI subtype. METHODS A retrospective analysis of all neurosurgical SSI from 2012-2019 was conducted at a tertiary care institution. SSI subtypes were categorized as deep and superficial incisional SSI, brain, dural or spinal abscesses, meningitis or ventriculitis, and osteomyelitis. RESULTS 9620 craniotomy, shunt, and fusion procedures were studied. 147 procedures (1.5%) resulted in postoperative SSI. 87 (59.2%) of these were associated with craniotomy, 36 (24.5%) with spinal fusion, and 24 (16.3%) with ventricular shunting. Compared with superficial incisional primary SSI, rates of reoperation to treat SSI were highest for deep incisional primary SSI (91.2% vs 38.9% for superficial, p < 0.001) and second-highest for intracranial SSI (90.9% vs 38.9%, p = 0.0001). Postoperative meningitis was associated with the highest mortality rate (14.9%). Compared with superficial incisional SSI, the rate of readmission for intracranial SSI was highest (57.6% vs 16.7%, p = 0.022). CONCLUSION Deep incisional and organ space SSI demonstrate a greater association with morbidity relative to superficial incisional SSI. Future studies should assess subtypes of SSI given these differences.
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Affiliation(s)
- Arjun R Adapa
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Joseph R Linzey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Badih J Daou
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | | | - Paul Park
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
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Li M, Sun G, Cui J, Lou Q. Risk factors for surgical site infection after closed proximal humerus fractures. Int Wound J 2024; 21:e14515. [PMID: 38009983 PMCID: PMC10898375 DOI: 10.1111/iwj.14515] [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] [Received: 10/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non-infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient-related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma-related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory-related indexes: haemoglobin, albumin; (4) surgery-related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI.
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Affiliation(s)
- Ming Li
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Guang‐chen Sun
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Jun Cui
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Qi‐liang Lou
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
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Schermann H, Hochberg U, Regev GJ, Salame K, Ofir D, Ankori R, Lidar Z, Khashan M. The effect of subcutaneous fat and skin-to-lamina distance on complications and functional outcomes of minimally invasive lumbar decompression. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05852-4. [PMID: 37249629 DOI: 10.1007/s00264-023-05852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Minimally invasive lumbar decompression (MIS) in obese pzatients is technically challenging due to the use of longer tube retractors. The purpose of this study was to evaluate the impact of the thickness of the soft tissue and subcutaneous fat on complications, revisions, and patient-reported functional outcomes after MIS. METHODS This is a retrospective analysis of 148 consecutive patients who underwent minimally invasive lumbar decompression at our institute between 2013 and 2017 and had at least one year of follow-up. Analysis was performed five times, each time the study group was defined by another measure of adiposity: BMI > 30, skin to lamina distance at the site of surgery and at L4 > 6 cm, and subcutaneous fat thickness at the site of surgery and at L4 > 3 cm. Outcomes included intraoperative complications (durotomy or neurological deficit), possibly inadequate decompression (residual disc, reoperation), length of stay, return to the emergency room or readmission, postoperative medical complications, and functional outcomes: visual analog scores for back and leg pain, and Oswestry Disability Index (ODI). RESULTS Patients with a thicker layer soft tissue had a significantly higher burden of comorbidities than controls, including higher prevalence of cardiovascular disease (p = 0.002), diabetes (p < 0.001), hypertension (p < 0.001) and higher ASA scores (p = 0.002). Nevertheless, there was no significant difference between the patient groups in surgical and medical complications, functional outcomes, and other assessed outcomes. CONCLUSION Our results indicate that minimally invasive lumbar decompression is safe and effective for patients with a thick layer of soft tissue and subcutaneous fat.
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Affiliation(s)
- Haggai Schermann
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
| | - Uri Hochberg
- Pain Clinic, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Gilad J Regev
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Khalil Salame
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Dror Ofir
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Ankori
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Zvi Lidar
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Morsi Khashan
- Spine Surgery Unit, Department of Neurosurgery, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
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Rommelman M, Safdar A, Motiei-Langroudi R. Effect of Obesity on Surgical Outcomes of Lumbar Microdiscectomy: A Retrospective Analysis of 525 Patients. Cureus 2023; 15:e39719. [PMID: 37398738 PMCID: PMC10309657 DOI: 10.7759/cureus.39719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Obesity has been implicated in higher rates of intra-operative complications, as well as increased risk for recurrent herniation and re-operation following lumbar microdiscectomy (LMD). However, the current literature is still controversial about whether obesity adversely affects surgical outcomes, especially a higher re-operation rate. In this study, we have compared surgical outcomes such as recurrence of symptoms, recurrence of disc herniation, and re-operation rates in obese and non-obese patients undergoing one segment LMD. METHODS A retrospective review was conducted on patients undergoing single-level LMD between 2010-2020 at an academic institution. Exclusion criteria included prior lumbar surgery. Outcomes assessed included the presence of persistent radicular pain, imaging evidence of recurrent herniation, and the need for re-operation due to recurrent herniation. RESULTS A total of 525 patients were included in the study. The mean±SD body mass index (BMI) was 31.2±6.6 (range 16.2-70.0). The mean follow-up was 273.8±445.2 days (range 14-2494). Reherniation occurred in 84 patients (16.0%), and 69 (13.1%) underwent re-operation due to persistent recurrent symptoms. Neither reherniation nor re-operation was significantly associated with BMI (p = 0.47 and 0.95, respectively). Probit analysis did not show any significant association between BMI and the need for re-operation following LMD. CONCLUSION Obese and non-obese patients experienced similar surgical outcomes. Our results showed that BMI did not adversely affect reherniation or re-operation rate following LMD. If clinically indicated, LMD can be performed in obese patients with disc herniation without a significantly higher re-operation rate.
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Affiliation(s)
| | - Aleeza Safdar
- Neurosurgery, University of Kentucky, Lexington, USA
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Yang S, Long Y, Wang T, Guo J, Hou Z. Predictors for surgical site infection after fasciotomy in patients with acute leg compartment syndrome. J Orthop Surg Res 2023; 18:98. [PMID: 36782284 PMCID: PMC9926640 DOI: 10.1186/s13018-023-03589-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common complications of orthopedic surgery, which can result in fever, pain, and even life-threatening sepsis. This study aimed to determine the predictors of SSI after fasciotomy in patients with acute leg compartment syndrome (ALCS). METHODS We collected information on 125 ALCS patients who underwent fasciotomy in two hospitals between November 2013 and January 2021. Patients with SSI were considered as the SSI group and those without SSI as the non-SSI group. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate patient demographics, comorbidities, and admission laboratory examinations. RESULTS In our research, the rate of SSI (26 of 125) was 20.8%. Several predictors of SSI were found using univariate analysis, including body mass index (BMI) (p = 0.001), patients with open fractures (p = 0.003), and patients with a history of smoking (p = 0.004). Besides, the levels of neutrophil (p = 0.022), glucose (p = 0.041), globulin (p = 0.010), and total carbon dioxide were higher in the SSI group than in the non-SSI group. According to the results of the logistic regression analysis, patients with open fractures (p = 0.023, OR 3.714), patients with a history of smoking (p = 0.010, OR 4.185), and patients with a higher BMI (p = 0.014, OR 1.209) were related predictors of SSI. Furthermore, ROC curve analysis indicated 24.69 kg/m2 as the cut-off value of BMI to predict SSI. CONCLUSIONS Our results revealed open fractures, BMI, and smoking history as independent risk factors for SSI following fasciotomy in patients with ALCS and determined the cut-off value of BMI, enabling us to individualize the evaluation of the risk for SSI to implement early targeted treatments.
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Affiliation(s)
- Shuo Yang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yubin Long
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei People’s Republic of China ,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China ,The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei People’s Republic of China
| | - Tao Wang
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei People’s Republic of China ,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
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9
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Development and validation of a point-of-care clinical risk score to predict surgical site infection following open spinal fusion. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 13:100196. [PMID: 36691580 PMCID: PMC9860512 DOI: 10.1016/j.xnsj.2022.100196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Background Surgical site infection (SSI) after open spine surgery increases healthcare costs and patient morbidity. Predictive analytics using large databases can be used to develop prediction tools to aid surgeons in identifying high-risk patients and strategies for optimization. The purpose of this study was to develop and validate an SSI risk-assessment score for patients undergoing open spine surgery. Methods The Premier Healthcare Database of adult open spine surgery patients (n = 157,664; 2,650 SSIs) was used to create an SSI risk scoring system using mixed effects logistic regression modeling. Full and reduced multilevel logistic regression models were developed using patient, surgery or facility predictors. The full model used 38 predictors and the reduced used 16 predictors. The resulting risk score was the sum of points assigned to 16 predictors. Results The reduced model showed good discriminatory capability (C-statistic = 0.75) and good fit of the model ([Pearson Chi-square/DF] = 0.90, CAIC=25,517) compared to the full model (C-statistic = 0.75, [Pearson Chi-square/DF] =0.90, CAIC=25,578). The risk scoring system, based on the reduced model, included the following: female (5 points), hypertension (4), blood disorder (8), peripheral vascular disease (9), chronic pulmonary disease (6), rheumatic disease (16), obesity (12), nicotine dependence (5), Charlson Comorbidity Index (2 per point), revision surgery (14), number of ICD-10 procedures (1 per procedure), operative time (1 per hour), and emergency/urgent surgery (12). A final risk score as the sum of the points for each surgery was validated using a 1,000-surgery random hold-out (independent from the study cohort) sample (C-statistic = 0.77). Conclusions The resulting SSI risk score composed of readily obtainable clinical information could serve as a strong prediction tool for SSI in preoperative settings when open spine surgery is considered.
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Abstract
The traditional complications of diabetes mellitus are well known and continue to pose a considerable burden on millions of people living with diabetes mellitus. However, advances in the management of diabetes mellitus and, consequently, longer life expectancies, have resulted in the emergence of evidence of the existence of a different set of lesser-acknowledged diabetes mellitus complications. With declining mortality from vascular disease, which once accounted for more than 50% of deaths amongst people with diabetes mellitus, cancer and dementia now comprise the leading causes of death in people with diabetes mellitus in some countries or regions. Additionally, studies have demonstrated notable links between diabetes mellitus and a broad range of comorbidities, including cognitive decline, functional disability, affective disorders, obstructive sleep apnoea and liver disease, and have refined our understanding of the association between diabetes mellitus and infection. However, no published review currently synthesizes this evidence to provide an in-depth discussion of the burden and risks of these emerging complications. This Review summarizes information from systematic reviews and major cohort studies regarding emerging complications of type 1 and type 2 diabetes mellitus to identify and quantify associations, highlight gaps and discrepancies in the evidence, and consider implications for the future management of diabetes mellitus.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Dong X, Zhou Y. Cross-sectional analysis of risk factors for surgical site infection secondary to spinal internal fixation via the posterior approach. J Int Med Res 2022; 50:3000605221099254. [PMID: 35579195 PMCID: PMC9130821 DOI: 10.1177/03000605221099254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to investigate the risk factors related to surgical
site infection (SSI) secondary to spinal internal fixation via the posterior
approach. Methods Patients who had undergone spinal internal fixation via the posterior
approach were selected for inclusion in this cross-sectional study. Factors
related to SSI were analysed using univariate and multivariate analyses. Results Among 4,350 patients, 66 had SSI (infection prevalence of 1.5%). Multivariate
logistic regression analysis demonstrated that age of >60 years, surgical
duration of >3 hours, haemoglobin concentration of <80 g/L, serum
albumin concentration of <30 g/L, diabetes history, and blood loss of
>1,000 mL were significantly correlated with SSI secondary to spinal
internal fixation via the posterior approach. Conclusions This study provides information on SSI secondary to spinal internal fixation
via the posterior approach. We found that age of >60 years, surgical
duration of >3 hours, haemoglobin concentration of <80 g/L, serum
albumin concentration of <30 g/L, diabetes history, and blood loss of
>1,000 mL are directly correlated with SSI secondary to spinal internal
fixation via the posterior approach.
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Affiliation(s)
- XiangHui Dong
- Orthopedics Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Yongchun Zhou
- Orthopedics Department, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
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12
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Bisson EF, Dimar J, Harrop JS, Hoh DJ, Mohamed B, Mummaneni PV, Wang MC, Dhall S. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Perioperative Spine: Preoperative Nutritional Assessment. Neurosurgery 2021; 89:S26-S32. [PMID: 34490884 DOI: 10.1093/neuros/nyab318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preoperative malnutrition has been implicated in adverse events after elective surgery, potentially impacting patient outcomes. OBJECTIVE As a potentially modifiable risk factor, we sought to determine which assessments of nutritional status were associated with specific adverse events after spine surgery. In addition, we explored if a preoperative nutritional improvement intervention may be beneficial in lowering the rates of these adverse events. METHODS The literature search yielded 115 abstracts relevant to the PICO (patient/population, intervention, comparison, and outcomes) questions included in this chapter. The task force selected 105 articles for full text review, and 13 met criteria for inclusion in this systematic review. RESULTS Malnutrition, assessed preoperatively by a serum albumin <3.5 g/dL or a serum prealbumin <20 mg/dL, is associated with a higher rate of surgical site infections (SSIs), other wound complications, nonunions, hospital readmissions, and other medical complications after spine surgery. A multimodal nutrition management protocol decreases albumin and electrolyte deficiencies in patients with normal preoperative nutritional status. It also improves overall complication rates but does not specifically impact SSIs. CONCLUSION It is recommended to assess nutritional status using either serum albumin or prealbumin preoperatively in patients undergoing spine surgery.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/4-preoperative-nutritional-assessment.
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Affiliation(s)
- Erica F Bisson
- Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah, USA
| | - John Dimar
- Department of Orthopedics, University of Louisville, Pediatric Orthopedics, Norton Children's Hospital, Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | - James S Harrop
- Department of Neurological Surgery and Department of Orthopedic Surgery, Thomas Jefferson University, Division of Spine and Peripheral Nerve Surgery, Delaware Valley SCI Center, Philadelphia, Pennsylvania, USA
| | - Daniel J Hoh
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Basma Mohamed
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Marjorie C Wang
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Sanjay Dhall
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
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13
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Lim S, Yeh HH, Macki M, Mansour T, Schultz L, Telemi E, Haider S, Nerenz DR, Schwalb JM, Abdulhak M, Park P, Aleem I, Easton R, Khalil J, Perez-Cruet M, Chang V. Preoperative HbA1c > 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study. Neurosurgery 2021; 89:819-826. [PMID: 34352887 DOI: 10.1093/neuros/nyab294] [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] [Received: 12/08/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preoperative hemoglobin A1c (HbA1c) is a useful screening tool since a significant portion of diabetic patients in the United States are undiagnosed and the prevalence of diabetes continues to increase. However, there is a paucity of literature analyzing comprehensive association between HbA1c and postoperative outcome in lumbar spine surgery. OBJECTIVE To assess the prognostic value of preoperative HbA1c > 8% in patients undergoing elective lumbar spine surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried to track all elective lumbar spine surgeries between January 2018 and December 2019. Cases were divided into 2 cohorts based on preoperative HbA1c level (≤8% and >8%). Measured outcomes include any complication, surgical site infection (SSI), readmission (RA) within 30 d (30RA) and 90 d (90RA) of index operation, patient satisfaction, and the percentage of patients who achieved minimum clinically important difference (MCID) using Patient-Reported Outcomes Measurement Information System. RESULTS We captured 4778 patients in this study. Our multivariate analysis demonstrated that patients with HbA1c > 8% were more likely to experience postoperative complication (odds ratio [OR] 1.81, 95% CI 1.20-2.73; P = .005) and be readmitted within 90 d of index surgery (OR 1.66, 95% CI 1.08-2.54; P = .021). They also had longer hospital stay (OR 1.12, 95% CI 1.03-1.23; P = .009) and were less likely to achieve functional improvement after surgery (OR 0.64, 95% CI 0.44-0.92; P = .016). CONCLUSION HbA1c > 8% is a reliable predictor of poor outcome in elective lumbar spine surgery. Clinicians should consider specialty consultation to optimize patients' glycemic control prior to surgery.
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Affiliation(s)
- Seokchun Lim
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Department of Public Health Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tarek Mansour
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Public Health Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Edvin Telemi
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - David R Nerenz
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.,Center for Health Services Research, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muwaffak Abdulhak
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilyas Aleem
- Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Easton
- Department of Orthopedics, William Beaumont Hospital, Troy, Michigan, USA
| | - Jad Khalil
- Department of Orthopedics, William Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Victor Chang
- Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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14
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Reyes AM, Katz JN, Schoenfeld AJ, Kang JD, Losina E, Chang Y. National utilization and inpatient safety measures of lumbar spinal fusion methods by race/ethnicity. Spine J 2021; 21:785-794. [PMID: 33227551 PMCID: PMC8113062 DOI: 10.1016/j.spinee.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/07/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degenerative lumbar conditions are prevalent, disabling, and frequently managed with decompression and fusion. Black patients have lower spinal fusion rates than White patients. PURPOSE Determine whether specific lumbar fusion procedure utilization differs by race/ethnicity and whether length of stay (LOS) or inpatient complications differ by race/ethnicity after accounting for procedure performed. STUDY DESIGN Large database retrospective cohort study PATIENT SAMPLE: Lumbar fusion recipients at least age 50 in the 2016 National Inpatient Sample with diagnoses of degenerative lumbar conditions. OUTCOME MEASURES Type of fusion procedure used and inpatient safety measures including LOS, prolonged LOS, inpatient medical and surgical complications, mortality, and cost. METHODS We examined the association between race/ethnicity and the safety measures above. Covariates included several patient and hospital factors. We used multiple linear or logistic regression to determine the association between race and fusion type (PLF, P/TLIF, ALIF, PLF + P/TLIF, and PLF + ALIF [anterior-posterior fusion]) and to determine whether race was associated independently with inpatient safety measures, after adjustment for patient and hospital factors. RESULTS Fusion method use did not differ among racial/ethnic groups, except for somewhat lower anterior-posterior fusion utilization in Black patients compared to White patients (crude odds ratio [OR]: 0.81 [0.67-0.97]). Inpatient safety measures differed by race/ethnicity for rates of prolonged LOS (Blacks 18.1%, Hispanics 14.5%, and Whites 11.7%), medical complications (Blacks 9.9%, Hispanics 8.7%, and Whites 7.7%), and surgical complications (Blacks 5.2%, Hispanics 6.9%, and Whites 5.4%). Differences persisted after adjustment for procedure type as well as patient and hospital factors. Blacks and Hispanics had higher risk for prolonged LOS compared to Whites (adjusted OR Blacks 1.39 [95% confidence interval {CI} 1.22-1.59]; Hispanics 1.24 [95% CI 1.02-1.52]). Blacks had higher risk for inpatient medical complications compared to Whites (adjusted OR 1.24 [95% CI 1.05-1.48]), and Hispanics had higher risk for inpatient surgical complications compared to Whites (adjusted OR 1.34 [95% CI 1.06-1.68]). CONCLUSIONS Fusion method use was generally similar between racial/ethnic groups. Inpatient safety measures, adjusted for procedure type, patient and hospital factors, were worse for Blacks and Hispanics.
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Affiliation(s)
- Angel M Reyes
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115 USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA.
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115 USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA; Division of Rheumatology, Section of Clinical Sciences, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115 USA; Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntingon Ave, Boston, MA 02115 USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 USA
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115 USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA; Division of Rheumatology, Section of Clinical Sciences, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115 USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 USA; Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave 3rd floor, Boston, MA 02118 USA
| | - Yuchiao Chang
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA; Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA 02114 USA
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15
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Carballo Cuello CM, Fernández-de Thomas RJ, De Jesus O, De Jesús Espinosa A, Pastrana EA. Prevention of Surgical Site Infection in Lumbar Instrumented Fusion Using a Sterile Povidone-Iodine Solution. World Neurosurg 2021; 151:e700-e706. [PMID: 33940260 DOI: 10.1016/j.wneu.2021.04.094] [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] [Received: 04/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a well-documented complication in patients who undergo posterior spine instrumentation with most studies reporting an incidence of 1%-12%. Some studies have documented that a diluted sterile povidone-iodine (PVI) solution can be safely used in posterior spinal fusion surgeries as an antiseptic; in this study, we analyzed its effectiveness in reducing SSI. METHODS This retrospective study consisted of consecutive patients who underwent elective posterior lumbar instrumentation performed by a single surgeon from 2016 to 2019. In the first 134 patients, wounds were irrigated before arthrodesis and closure with 1 L of 0.9% normal saline solution; in the subsequent 144 patients, wound irrigation was with a solution of 35 mL of sterile 10% PVI. Both groups were analyzed to determine if wound irrigation with sterile PVI solution decreased SSIs. RESULTS There were 9 (6.7%) SSIs in the 0.9% normal saline solution group versus 1 (0.7%) SSI in the PVI group (P = 0.008). PVI solution had a relative risk for SSI of 0.093 (P = 0.008) and an adjusted odds ratio of 0.113 (P = 0.05). Increased body mass index and posterolateral spine fusion with laminectomy were significant risk factors for SSI (P = 0.04 and P = 0.030, respectively). CONCLUSIONS Wound irrigation with PVI solution significantly reduced SSI in elective posterior lumbar instrumentation cases. Subgroup analysis provided significant results to recommend use of PVI solution for SSI prevention, particularly in overweight and obese patients. We also recommend its use in patients with risk factors for SSI, such as longer operative time and unintended durotomy.
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Affiliation(s)
- César M Carballo Cuello
- Neurosurgery Section, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Orlando De Jesus
- Neurosurgery Section, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Aixa De Jesús Espinosa
- Neurosurgery Section, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Emil A Pastrana
- Neurosurgery Section, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
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16
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BMI Does Not Affect Complications or Patient Reported Outcomes After Lumbar Decompression Surgery. Clin Spine Surg 2020; 33:E579-E585. [PMID: 32349060 DOI: 10.1097/bsd.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a retrospective comparative review. OBJECTIVE The objective of this study was to identify the influence of body mass index (BMI) on postsurgical complications and patient reported outcomes measures (PROMs) following lumbar decompression surgery. SUMMARY OF BACKGROUND DATA Current literature does not accurately identify the impact of BMI on postsurgical complications or outcomes. MATERIALS AND METHODS Records from a single-center, academic hospital were used to identify patients undergoing 1 to 3-level lumbar decompression surgery. Patients under 18 years of age, those undergoing surgery for infection, trauma, tumor, or revision, and those with <1-year follow-up were excluded. Patients were split into groups based on preoperative BMI: class I: BMI <25.0 kg/m; class II: BMI 25.0-29.9 kg/m; class III: BMI 30.0-34.9 kg/m; and class IV: BMI >35.0 kg/m. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed. RESULTS A total of 195 patients were included with 34 (17.4%) patients in group I, 80 (41.0%) in group II, 49 (25.1%) in group III, and 32 (16.5%) in group IV. Average age was 60.0 (58.0, 62.0) years and average follow-up was 13.0 (12.6, 13.4) months. All patients improved significantly within each group, except for class III and class IV patients, who did not demonstrate significant improvements in terms of Mental Component Score (MCS-12) scores (P=0.546 and 0.702, respectively). There were no significant differences between BMI groups for baseline or postoperative PROM values, recovery ratio, or the percent of patients reaching minimum clinically important difference. Multiple linear regression analysis revealed that BMI was not a significant predictor for change in outcomes for any measure. The 30-day readmission rate was 6.2% and overall revision rate at final follow-up was 5.1%, with no significant differences between groups. CONCLUSION This study's results suggest that BMI may not significantly affect complications or patient outcomes at 1-year in those undergoing lumbar decompression surgery. LEVEL OF EVIDENCE Level III.
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17
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Kalfas F, Severi P, Scudieri C. Infection with Spinal Instrumentation: A 20-Year, Single-Institution Experience with Review of Pathogenesis, Diagnosis, Prevention, and Management. Asian J Neurosurg 2019; 14:1181-1189. [PMID: 31903360 PMCID: PMC6896624 DOI: 10.4103/ajns.ajns_129_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective and Importance Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Postoperative spinal implant infection places patients at risk for pseudo-arthrosis, correction loss, spondylodiscitis, and adverse neurological sequelae and increases health-care costs. Materials and Methods We performed a cohort study of 1065 patients who underwent instrumented spinal procedures in our institution between 1995 and 2014. Fifty-one patients (4.79%) contracted postoperative spinal infection. Isolated bacterial species, infection severity, diagnosis/treatment timing, surgical/medical strategy treatment, and patient's medical background were evaluated to assess their relationship with management outcome. Results Multiple risk factors for postoperative spinal infection were identified. Infections may be early or delayed. C-reactive protein and magnetic resonance imaging are important diagnostic tools. Prompt diagnosis and aggressive therapy (debridement and parenteral antibiotics) were responsible for implant preservation in 49 of 51 cases, whereas implant removal noted in two cases was attributed to delayed treatment and uncontrolled infection with implant loosening or late infection with spondylodesis. Infection in the setting of instrumentation is more difficult to diagnose and treat due to biofilm. Conclusion Retention of the mechanically sound implants in early-onset infection permits fusion to occur, whereas delayed treatment and multiple comorbidities will most likely result in a lack of effectiveness in eradicating the infecting pathogens. An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight into the pathogenesis and management of infected spinal implants. It is important to accurately identify and treat postoperative spinal infections. The treatment is multimodal and prolonged.
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Affiliation(s)
- Fotios Kalfas
- Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
| | - Paolo Severi
- Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
| | - Claudia Scudieri
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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18
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Beack JY, Chun HJ, Bak KH, Choi KS, Bae IS, Kim KD. Risk Factors of Secondary Lumbar Discectomy of a Herniated Lumbar Disc after Lumbar Discectomy. J Korean Neurosurg Soc 2019; 62:586-593. [PMID: 31484233 PMCID: PMC6732352 DOI: 10.3340/jkns.2019.0085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/30/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.
Methods Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.
Results The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4–5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).
Conclusion Patients with high BMI or severe disc degeneration should be informed of HLD revision.
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Affiliation(s)
- Joo Yul Beack
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Koang Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - In-Suk Bae
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis, CA, USA
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19
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Adult Spinal Arteriovenous Malformations: Natural History and a Multicenter Study of Short-Term Surgical Outcomes. World Neurosurg 2019; 132:e290-e296. [PMID: 31479792 DOI: 10.1016/j.wneu.2019.08.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Spinal arteriovenous malformations (SAVMs) are a very rare and complex spinal cord pathology that require high clinical acumen to diagnose and treat. Management includes both nonoperative and operative paradigms. A review of the literature yields a paucity of data regarding the surgical outcomes of SAVMs, with the majority of data limited to single-center outcomes and/or small sample sizes. The purpose of this study was to use a multi-institutional international database to study the natural history of SAVMs. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to select patients that underwent laminectomy for surgical excision of a SAVM between 2008 and 2017. RESULTS The data from 196 patients were studied (65.8% male, 34.2% female). A majority of cases were in the thoracic region (53.6%), followed by thoracolumbar (31.6%) and cervical (14.8%) regions. The mean age was 57.4 years and 52.5% patients were graded ASA class 3-5 before the operation. The mean operation time was 215 minutes, with a significantly lower operative time for thoracic arteriovenous malformations (195.6 minutes) when compared with cervical (266.6 minutes) and thoracolumbar (223.7 minutes). The mean length of hospital stay was 6.4 days. Patients had a 6.6% readmission rate and a 4.6% reoperation rate within 30 days. CONCLUSIONS This study presents the largest analysis of patients undergoing surgery for SAVMs and 30-day postoperative outcomes. Operative time differed based on SAVM location. The three most frequent complications (deep vein thrombosis, wound infection, and UTI) occurred at rates of 3.6% or less.
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20
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Burton DC, Sethi RK, Wright AK, Daniels AH, Ames CP, Reid DB, Klineberg EO, Harper R, Mundis GM, Hlubek RJ, Bess S, Hart RA, Kelly MP, Lenke LG. The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal Deformity Surgery: A Systematic Review, Part 1. Spine Deform 2019; 7:669-683. [PMID: 31495466 DOI: 10.1016/j.jspd.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Structured Literature Review. OBJECTIVES We sought to evaluate the peer-reviewed literature for potentially modifiable patient and surgical factors that could be incorporated into a Standard Work protocol to decrease complications in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Lean Methodology uses Standard Work to improve efficiency and decrease waste and error. ASD is known to have a high surgical complication rate. Several patient and surgical potentially modifiable factors have been suggested to affect complications, including preoperative hemoglobin, bone density, body mass index (BMI), age-appropriate realignment, preoperative albumin/prealbumin, and smoking status. We sought to evaluate the literature for evidence supporting these factors to include in a Standard Work protocol to decrease complications. METHODS Each of these six factors was developed into an appropriate clinical question that included the patient population, surgical intervention, a comparison group, and outcomes measure (PICO question). A comprehensive literature search was then performed. The authors reviewed abstracts and analyzed data from included studies. From 456 initial citations with abstract, 173 articles underwent full-text review. The best available evidence for clinical questions regarding the influence of these factors was provided by 93 included studies. RESULTS We found fair evidence supporting a low preoperative hemoglobin level associated with increased transfusion rates and decreased BMD and increased BMI associated with increased complication rates. Fair evidence supported low albumin/prealbumin associated with increased complications. There was fair evidence associating smoking exposure to increased reoperations, but conflicting evidence associating it with increased complications. There was no evidence in the literature evaluating age-appropriate realignment and complications. CONCLUSION Preoperative hemoglobin, bone density, body mass index, preoperative albumin/prealbumin, and smoking status all are potentially modifiable risk factors that are associated with increased complications in the adult spine surgery population. Developing a Standard Work Protocol for patient evaluation and optimization should include these factors. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Rajiv K Sethi
- Neuroscience Institute, Virginia Mason Hospital, 1100 Ninth Avenue, Seattle, WA 98101, USA; Department of Health Services, University of Washington, NE Pacific Street, Seattle, WA 98195, USA
| | - Anna K Wright
- Neuroscience Institute, Virginia Mason Hospital, 1100 Ninth Avenue, Seattle, WA 98101, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University, 222 Richmond Street, Providence, RI 02912, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA 94131, USA
| | - Daniel B Reid
- Department of Orthopedics, Brown University, 222 Richmond Street, Providence, RI 02912, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, 1 Shields Avenue, Davis, CA 95616, USA
| | - Robert Harper
- Department of Orthopedic Surgery, University of California, 1 Shields Avenue, Davis, CA 95616, USA
| | - Gregory M Mundis
- San Diego Spine Foundation, 6190 Cornerstone Ct. E, Suite 212, San Diego, CA 92121, USA
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's Medical Center, Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA
| | - Robert A Hart
- Swedish Neuroscience Institute, 550 17th Avenue, Suite 540, Seattle, WA 98122, USA
| | - Michael P Kelly
- Department of Orthopaedics, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO 63130, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, Och Spine Hospital, 5141 Broadway, New York, NY 10034, USA
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Heyer JH, Cao NA, Amdur RL, Rao RR. Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women? Int J Spine Surg 2019; 13:125-131. [PMID: 31131211 DOI: 10.14444/6017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Patient sex is known to affect outcomes following surgery. Prior studies have not specifically examined sex-stratified outcomes following spine surgery. The objective is to determine the differences between men and women in terms of 30-day complications following spine surgery. Methods The National Surgical Quality Improvement Program database was queried for patients undergoing spine surgery from 2005 to 2014. Postoperative data were analyzed to determine the differences between men and women with regard to 30-day complications. Results A total of 41 315 patients (49.0% women, 51% men) were analyzed. Men were more likely to have diabetes (P = .004) and be active smokers (P < .001). Women were more likely to be taking steroids for chronic conditions (P < .001). Postoperatively, women were at increased risk for superficial surgical site infection, urinary tract infection, transfusions, and longer length of stay, whereas men were at increased risk of pneumonia and reintubation. On multivariate analysis, women were associated with urinary tract infections (odds ratio = 2.17) and transfusions (odds ratio = 1.63). Conclusions Differences in complications are evident between men and women following spine surgery. These differences should be considered during preoperative planning and when consenting patients for surgery. Level of Evidence 4.
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Affiliation(s)
- Jessica H Heyer
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - N A Cao
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - Richard L Amdur
- Medical Faculty Associates, Department of Surgery, George Washington University, Washington, DC
| | - Raj R Rao
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
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Byvaltsev VA, Stepanov IA, Borisov VE, Kalinin AA. [Local administration of vancomycin powder in posterior lumbar fusion surgery]. Khirurgiia (Mosk) 2019:58-64. [PMID: 30855592 DOI: 10.17116/hirurgia201902158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate an efficacy of local administration of vancomycin powder in posterior lumbar fusion surgery for prevention of local infection. MATERIAL AND METHODS The study included 214 patients. All patients were divided into 2 groups: I group (control) and II (experimental). Patients of the first group underwent conventional antibiotic prophylaxis of wound infections, in group II traditional antibiotic prophylaxis was supplemented by local administration of vancomycin powder 1 g prior to wound closure. RESULTS There were 12 cases of wound infection in group I and 5 cases in group II. There were significant differences in overall incidence of wound infection and wound infections caused by S. aureus (p=0.035; p=0.044, respectively). Significant risk factors of local infection were determined in group II: obesity, diabetes mellitus, arterial hypertension, coronary artery disease, length of hospital-stay and previous lumbosacral spinal surgery. Multivariate analysis revealed following risk factors of wound infection: diabetes mellitus, arterial hypertension, coronary artery disease, the number of involved spinal segments and previous lumbosacral spinal surgery. CONCLUSION Local application of vancomycin powder in posterior lumbar fusion surgery significantly reduces the incidence of wound infection.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital on the Irkutsk-Passazhirskiy station of Russian Railways Ltd., Irkutsk, Russia; Irkutsk Research Center of Surgery and Traumatology, Irkutsk, Russia; Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia
| | - V E Borisov
- Irkutsk State Medical University, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital on the Irkutsk-Passazhirskiy station of Russian Railways Ltd., Irkutsk, Russia; Irkutsk Research Center of Surgery and Traumatology, Irkutsk, Russia
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Ji C, Zhu Y, Liu S, Li J, Zhang F, Chen W, Zhang Y. Incidence and risk of surgical site infection after adult femoral neck fractures treated by surgery: A retrospective case-control study. Medicine (Baltimore) 2019; 98:e14882. [PMID: 30882697 PMCID: PMC6426521 DOI: 10.1097/md.0000000000014882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022] Open
Abstract
Surgical site infections (SSI) are devastating complications after surgery for femoral neck fractures. There are a lot of literature have shown a strong association between diabetic patients and SSI. This study aimed to identify diabetes as an independent risk factor of SSI, focusing on femoral neck fractures, and to investigate the other potential risk factors for SSI.We retrospectively collected data from patients who underwent surgery for femoral neck fractures through the medical record management system at a single level 1 hospital between January 2015 and June 2016. Demographic and clinical patient factors and characteristics of SSI were recorded. The case group was defined as patients with SSI and the control group was defined as patients without SSI. Univariate and multivariate analyses were performed to determine the risk factors for SSI.Data were provided for 692 patients, among whom 26 had SSI, representing an incidence rate of 3.67%. In the SSI group, 24 (3.47%) patients had superficial infection and 2 (0.29%) had deep infection. On multivariate analysis, diabetes (P < .001) was determined an independent risk factor of SSI, so were surgery performed between May and September (P = .04), body mass index (P = .031), corticosteroid therapy (P = .003), anemia (P = .041), and low preoperative hemoglobin levels.Our results suggest that clinicians should recognize patients with these factors, particularly diabetes. And taking management optimally in the preoperative period will prevent the SSI after femoral neck fracture.
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Affiliation(s)
- Chenni Ji
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Song Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Jia Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Fei Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei
- Chinese Academy of Engineering, Beijing, P.R. China
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Worm PV, Finger G, Brasil AVB, Teles AR. Postoperative Supine Position Increases the Risk of Infection After Spinal Surgery by Posterior Approach. World Neurosurg 2019; 126:e580-e585. [PMID: 30831303 DOI: 10.1016/j.wneu.2019.02.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spine surgeries performed via the posterior approach have a higher infection rate. Several theories have been proposed, including poor hygienic condition of bed sheets and traumatized muscle associated with supine position promoting circulatory impairment. We investigated the influence of supine position on the rate of deep wound infection after spine surgery by the posterior approach. METHODS A total of 106 patients were randomly divided into 2 groups: lateral decubitus only versus dorsal and lateral decubitus. Patient follow-up after hospital discharge was performed at 30, 60, 180, and 360 days. Deep wound infection was diagnosed according to U.S. Centers for Disease Control and Prevention criteria. RESULTS Patient sample was mainly composed of patients with neoplastic disease and patients with trauma. Postoperative wound infection developed in 12 cases (11.3%), and Streptococcus aureus was the most common pathogen. Incidence of postsurgical deep wound infection was significantly greater in the control group (P = 0.004). CONCLUSIONS Supine position was significantly correlated with higher rates of wound infection among patients who underwent spine surgery by the posterior approach. Avoidance of supine position may represent a modifiable risk factor to diminish postoperative spine infection rates.
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Affiliation(s)
- Paulo Valdeci Worm
- Department of Neurological Surgery, Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Guilherme Finger
- Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | - Albert Vincent Berthier Brasil
- Department of Neurological Surgery, Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Ventriculitis and Post Operative Spinal Infection. Neurosurgery 2019. [DOI: 10.1007/978-3-319-98234-2_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ranson WA, White SJW, Cheung ZB, Mikhail C, Ye I, Kim JS, Cho SK. The Effects of Chronic Preoperative Steroid Therapy on Perioperative Complications Following Elective Posterior Lumbar Fusion. Global Spine J 2018; 8:834-841. [PMID: 30560036 PMCID: PMC6293428 DOI: 10.1177/2192568218775960] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Chronic steroid therapy is used in the treatment of various inflammatory and autoimmune conditions, but it is known to be associated with adverse effects. There remains a gap in the literature regarding the role of chronic steroid therapy in predisposing patients to perioperative complications following elective posterior lumbar fusion (PLF). We aimed to identify the effects of chronic preoperative steroid therapy on 30-day perioperative complications in patients undergoing PLF. METHODS A retrospective analysis was performed using the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. We identified 22 903 patients who underwent elective PLF. There were 849 patients (3.7%) who received chronic preoperative steroid therapy. Univariate and multivariate analyses were performed to examine steroid therapy as an independent risk factor for 30-day perioperative complications. A subgroup analysis of patients on chronic steroid therapy was then performed to identify additional patient characteristics that further increased the risk for perioperative complications. RESULTS Chronic preoperative steroid therapy was an independent risk factor for 7 perioperative complications, including superficial surgical site infection (SSI), deep SSI, wound dehiscence, urinary tract infection, pulmonary embolism, nonhome discharge, and readmission. Subgroup analysis demonstrated that morbid obesity further predisposed patients on chronic steroid therapy to an increased risk of superficial SSI and wound dehiscence. CONCLUSIONS Patients on chronic preoperative steroid therapy are at increased risk of multiple perioperative complications following elective PLF, particularly surgical site complications and venous thromboembolic events. This risk is further elevated in patients who are morbidly obese.
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Affiliation(s)
| | | | - Zoe B. Cheung
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ivan Ye
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedic Surgery,
Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 4th Floor, New York, NY
10029, USA.
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Flentje KM, Knight CL, Stromfeldt I, Chakrabarti A, Friedman ND. Recording patient bodyweight in hospitals: are we doing well enough? Intern Med J 2018; 48:124-128. [PMID: 28589617 DOI: 10.1111/imj.13519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/16/2017] [Accepted: 05/28/2017] [Indexed: 11/29/2022]
Abstract
Recording patient weight is a standard practice for all hospital admissions, with this measurement influencing other daily practices that rely on the delivery of safe and effective patient care. Patient weight is important in the areas of medication prescribing, fluid balance and assessment of nutrition. In particular, prescribing narrow therapeutic index medications may result in significant harm as a potential consequence of inaccurate dosing. Despite its importance, it is evident that bodyweight measurements are recorded in only 13.5-55% of hospital patients, in a variety of settings including the emergency department, intensive care unit, medical and surgical wards. Barriers to compliance of healthcare staff include additional workload, patient handling and availability of appropriate weighing equipment. Hospitals and patients would benefit from enhancing compliance with the systematic weighing of patients, staff training and removing barriers to performing this task.
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Affiliation(s)
- Kate M Flentje
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Colin L Knight
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ingrid Stromfeldt
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Anindita Chakrabarti
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - N Deborah Friedman
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
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Hypoalbuminemia Is Associated With Septic Revisions After Primary Surgery and Postoperative Infection After Revision Surgery. Spine (Phila Pa 1976) 2018; 43:454-460. [PMID: 29016434 DOI: 10.1097/brs.0000000000002436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE To determine (1) the relationship between hypoalbuminemia and body mass index (BMI); (2) the association between malnutrition and revision spine surgery for septic reasons; and (3) the association between malnutrition and infection after aseptic revision spine surgery. SUMMARY OF BACKGROUND DATA Although malnutrition has been suggested to increase the risk of infection after spine surgery, evidence supporting this hypothesis is conflicting. METHODS Patients undergoing revision spine surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2014. Hypoalbuminemia (albumin < 3.5 g/dL) was used as a surrogate marker of malnutrition. Multivariate analysis was used to assess the association of hypoalbuminemia with septic versus aseptic revision spine surgery. The association between hypoalbuminemia and deep infection postoperatively within 30 days of aseptic revision surgeries was also assessed. RESULTS A total of 3136 patients who underwent revision spine surgery were identified; 2922 (93.2%) underwent surgery for aseptic reasons, and 214 (6.8%) for septic reasons. Hypoalbuminemia was present in all BMI groups including obese patients, though it was highest in underweight patients (22.4%). Patients who underwent surgery for septic reasons had a higher rate of hypoalbuminemia than those undergoing surgery for aseptic reasons (49.1% vs. 8.5%, P < 0.001) with nine times the odds of having hypoalbuminemia (adjusted odds ratio, OR = 9.17, P < 0.001). Of the 2922 patients undergoing revision spine surgery for aseptic reasons, hypoalbuminemia was independently associated with acute deep infection within 30 days of surgery (adjusted OR = 2.85, P = 0.019). CONCLUSION Malnutrition is more common in revision spine surgery for septic reasons when compared with aseptic revision surgery. Acute postoperative infection following aseptic revision surgery is also more common in patients with malnutrition. Further study, in the form of prospective trials, will help to increase our understanding of the effects of malnutrition in spine surgery. LEVEL OF EVIDENCE 3.
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Does Obesity Affect Perioperative and Postoperative Morbidity and Complication Rates After Minimal Access Spinal Technologies in Surgery for Lumbar Degenerative Disc Disease. World Neurosurg 2018; 111:e374-e385. [DOI: 10.1016/j.wneu.2017.12.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022]
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Perioperative Medical Complications after Posterior Approach Spinal Instrumentation Surgery for Osteoporotic Vertebral Collapse: A Comparative Study in Patients with Primary Osteoporosis and Those with Secondary Osteoporosis. Asian Spine J 2017; 11:756-762. [PMID: 29093786 PMCID: PMC5662859 DOI: 10.4184/asj.2017.11.5.756] [Citation(s) in RCA: 8] [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: 12/13/2016] [Revised: 02/21/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022] Open
Abstract
Study Design A retrospective comparative study. Purpose To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis. Overview of Literature With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis. Methods Ninety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared. Results Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p<0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal. Conclusions The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.
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Risk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based study. Acta Neurochir (Wien) 2017; 159:1113-1118. [PMID: 28424918 DOI: 10.1007/s00701-017-3184-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are no previous studies evaluating risk factors for surgical site infections (SSIs) and the effectiveness of prophylactic antibiotic treatment (PAT), specifically for patients operated on for lumbar disc herniation. METHOD This observational multicentre study comprises a cohort of 1,772 consecutive patients operated on for lumbar disc herniation without laminectomy or fusion at 23 different surgical units in Norway. The patients were interviewed about SSIs according to a standardised questionnaire at 3 months' follow-up. RESULTS Three months after surgery, 2.3% of the patients had an SSI. Only no PAT (OR = 5.3, 95% CI = 2.2-12.7, p< 0.001) and longer duration of surgery than the mean time (68 min) (OR = 2.8, 95% CI = 1.2-6.6, p = 0.02) were identified as independent risk factors for SSI. Numbers needed to have PAT to avoid one SSI was 43. CONCLUSIONS In summary, this study clearly lends support to the use of PAT in surgery for lumbar disc herniation. Senior surgeons assisting inexperienced colleagues to avoid prolonged duration of surgery could also reduce the occurrence of SSI.
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Mastoraki A, Mastoraki S, Papanikolaou IS, Tsikala-Vafea M, Tsigou V, Lazaris A, Arkadopoulos N. Spondylodiscitis Associated with Major Abdominal Surgical Intervention: Challenging Diagnostic and Therapeutic Modalities. Indian J Surg Oncol 2017; 8:274-278. [DOI: 10.1007/s13193-017-0641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 02/27/2017] [Indexed: 11/28/2022] Open
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Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury 2017; 48:307-321. [PMID: 27912931 DOI: 10.1016/j.injury.2016.11.026] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/05/2016] [Accepted: 11/21/2016] [Indexed: 02/02/2023]
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Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study. Infect Control Hosp Epidemiol 2016; 38:340-347. [PMID: 27989249 DOI: 10.1017/ice.2016.307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Readmission Rates, Reasons, and Risk Factors in Elderly Patients Treated With Lumbar Fusion for Degenerative Pathology. Spine (Phila Pa 1976) 2016; 41:1933-1938. [PMID: 27275579 DOI: 10.1097/brs.0000000000001631] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE To determine readmission rates after 1 to 2 level, primary, elective lumbar spinal fusion surgery for degenerative pathology and elucidate risk factors that predict increased risk of 30-day readmission SUMMARY OF BACKGROUND DATA.: Early postoperative readmissions after spine surgery represent a significant source of increased cost and morbidity. As the elderly population represents a demographic with a growing need for spine surgery, readmissions within this population are of significant interest. METHODS Medicare data (2005-2012) from an insurance database was queried for patients who underwent primary 1 to 2 level posterolateral lumbar spine fusion surgeries for degenerative lumbar pathology. After applying specific exclusion criteria to select for elderly patients (65-84 yr) undergoing mostly elective procedures, 52,567 patients formed the final study population. Readmission rates for medical, surgical, and all reasons were calculated within 30 days, 90 days, and 1 year postoperatively. Risk factors for medical, surgical, and all 30-day readmissions were also determined. RESULTS Within 30 days, 90 days, and 1 year, 1510 (2.9%), 2776 (5.3%), and 6574 (12.5%) patients were readmitted, respectively. At 30 days, surgical diagnoses constituted 50.1% of all readmissions. Wound infection was the reason for readmission in 25.8% of all readmissions within 30 days. Diagnoses of chronic pulmonary disease (OR 1.41 95% CI 1.22-1.63), obesity (OR 2.20 95% CI 1.90-2.54), and positive smoking history (OR 1.33 95% CI 1.15-1.54) were associated with increased risk of surgical readmission. CONCLUSION Elderly patients undergoing lumbar spine fusion experience 30-day, 90-day, and 1-year readmission rates of 2.9, 5.3, and 12.5% for both medical and surgical reasons. Surgical site infection and wound complications are the most common surgery-related reasons for readmission. Medical diagnoses are more predominant during later readmissions, highlighting the comorbidity burden present in elderly patients. LEVEL OF EVIDENCE 4.
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Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections? Asian Spine J 2016; 10:1000-1006. [PMID: 27994774 PMCID: PMC5164988 DOI: 10.4184/asj.2016.10.6.1000] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/16/2016] [Accepted: 05/07/2016] [Indexed: 01/09/2023] Open
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. PURPOSE To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. OVERVIEW OF LITERATURE SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. METHODS All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. RESULTS A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. CONCLUSIONS Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.
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Kudo D, Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Mizutani T, Shimada Y. Relationship between preoperative serum rapid turnover proteins and early-stage surgical wound 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; 26:3156-3161. [PMID: 27832364 DOI: 10.1007/s00586-016-4855-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 10/03/2016] [Accepted: 10/28/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Malnutrition is one of the important risk factors for postoperative complications. Transferrin, prealbumin, and retinol-binding protein, so-called rapid turnover proteins (RTPs), may be the better indicators for early detection of nutritional deficits. However, few studies have described the impact of serum RTP levels on postoperative surgical site infection (SSI) in spine surgery. The purpose of this study was to investigate the relationship between preoperative serum RTPs and postoperative SSI. METHODS The data of 105 patients (64 male, 41 female; average age 64.4 years; age range 20-88 years) who underwent spine surgery in a single institution between 2014 and 2015 were retrospectively analyzed. Preoperative total lymphocyte count, serum albumin, transferrin, prealbumin, retinol-binding protein, pre-and postopeartive C-reactive protein (CRP), white blood cell count (WBC), and total lymphocyte count were evaluated. Postoperative CRP, WBC, and total lymphocyte count were repeated two or three times/week until hospital discharge. A broad spectrum penicillin or second generation cephalosporin was administered as a prophylactic antibiotic to each patient. When repeated CRP elevation or lymphopenia (no more than 10% or 1000/μL) after postoperative day 3 or 4 was observed, possible SSI was diagnosed. Variables between possible SSI group and non-SSI group were compared using Mann-Whitney U or Chi square test. All variables on univariate analysis were included in multiple logistic regression analysis to identify risk factors for possible postoperative SSI. RESULTS Thirty-five patients were diagnosed with possible SSI. The mean operative time of possible SSI group was significantly longer (p = 0.036), preoperative total lymphocyte count and serum prealbumin level of possible SSI group were significantly lower (p = 0.002, p = 0.048, respectively) than that of non-SSI group. On univariate analysis, operative time (p = 0.012), preoperative total lymphocyte count (p = 0.041), serum albumin level (p = 0.038), and serum prealbumin level (p = 0.044) were significant contributors to possible SSI, and multiple logistic regression analysis revealed that operative time was the significant contributor to possible SSI (odds ratio 1.008, 95% confidence interval (CI) 1.001-1.015, p = 0.024). CONCLUSIONS A low prealbumin level is a possible risk factor for early-stage SSI in spine surgery, though it was not statistically significant; operative time was the most important indicator of SSI on multivariate analysis.
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Affiliation(s)
- Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takashi Mizutani
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Invasiveness Index as a Predictor of Surgical Site Infection after Spinal Fusion, Revision Fusion, or Laminectomy. Infect Control Hosp Epidemiol 2016; 38:11-17. [PMID: 27825395 DOI: 10.1017/ice.2016.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate invasiveness index as a potential predictor of spine surgical site infection (SSI) after spinal fusion, revision fusion, or laminectomy. DESIGN Retrospective cohort study. SETTING Single, large, academic medical center. PATIENTS Adults undergoing spinal fusion, revision fusion, or laminectomy. METHODS Data were obtained from electronic hospital databases; cases of SSI were extracted from the infection control database using National Healthcare Safety Network (NHSN) definitions. For each case, an invasiveness index, determined by surgical approach, procedure, and number of spine levels treated, was calculated using current procedural terminology (CPT) billing codes. Statistical analyses were performed using univariate and multivariate logistic regression models. RESULTS In total, 3,143 patients met inclusion criteria, and 43 of these developed SSI. Multivariate regression showed that advanced age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.005-1.05, for each year of life) and invasiveness index (medium invasiveness index OR, 5.36; 95% CI, 1.92-14.96; high invasiveness index OR, 14.1; 95% CI, 4.38-45.43) were significant predictors of infection. In subgroup analyses of spinal fusion patients, morbid obesity (OR, 2.542; 95% CI, 1.08-5.99), trauma (OR, 2.41; 95% CI, 1.05-5.55), and invasiveness index (medium invasiveness index OR, 5.39; 95% CI, 1.56-18.61; high invasiveness index OR, 13.44; 95% CI, 3.28-55.01) were significant predictors of SSI. Models containing invasiveness index were compared to NHSN models and demonstrated similar performance. CONCLUSIONS Invasiveness index is a predictor of SSI after spinal fusion and performs similarly to NHSN models. Invasiveness index shows promise as a potential risk stratification tool that is easily calculated and is available preoperatively. Infect Control Hosp Epidemiol 2016:1-7.
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Klemencsics I, Lazary A, Szoverfi Z, Bozsodi A, Eltes P, Varga PP. Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Spine J 2016; 16:1377-1383. [PMID: 27520077 DOI: 10.1016/j.spinee.2016.08.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 06/11/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical site infection (SSI) is one of the most serious complications of spine surgery. Its predisposing factors, especially in routine surgeries, are less reported. However, a number of patient- and procedure-related risk factors could be avoided or at least determined preoperatively. Moreover, the patient-specific risk for SSI could be estimated before the elective surgery. PURPOSE The aim of the present study was to analyze the preoperatively determinable risk factors for SSI in patients who require elective routine surgery related to lumbar disc degeneration and to build a multivariable model for the individual risk prediction. STUDY DESIGN Analysis of prospectively collected standardized clinical data and the validation of the results on an independent prospective cohort were performed. PATIENT SAMPLE One thousand thirty (N=1,030) patients were included in the study. All subjects underwent primary lumbar single- or two-level decompression, microdiscectomy, or instrumented fusion. OUTCOME MEASURES Occurrence of an SSI defined according to the current Centers for Disease Control and Prevention guidelines that required surgical or nonsurgical therapy. METHODS The effect of preoperative patient characteristics, comorbidities, disease history, and invasiveness of the elective surgery on the risk of SSI was determined in uni- and multivariate logistic regression models in the test cohort (N=723). The performance of the final multivariable regression model was assessed by measuring its discriminative ability (c-index) in receiver operating characteristic analysis. Performance of the multivariable risk estimation model was tested on the validation (N=307) cohort. RESULTS The prevalence of SSI was 3.5% and 3.9% in the test and in the validation cohorts, respectively. The final multivariable regression model predictive (p=.003) for SSI contained the patient's age, body mass index (BMI), and the presence of 5 comorbidities, such as diabetes, ischemic heart disease, arrhythmia, chronic liver disease, and autoimmune disease as risk factors. The c-index of the model was 0.71, showing good discriminative ability, and it was confirmed by the data of the independent validation cohort (c=0.72). CONCLUSIONS Predisposing factors for SSI were older age, higher BMI, and the presence of certain comorbidities in the present study. The cumulative number of risk factors significantly associated with the increasing risk for an SSI (p<.0001). Our model needs further validation but it may be used for individual risk assessment and reduction in the future.
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Affiliation(s)
- Istvan Klemencsics
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.
| | - Zsolt Szoverfi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Arpad Bozsodi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Peter Eltes
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Peter Pal Varga
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
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Antoniadis A, Ulrich NH, Schmid S, Farshad M, Min K. Decompression surgery for lumbar spinal canal stenosis in octogenarians; a single center experience of 121 consecutive patients. Br J Neurosurg 2016; 31:67-71. [DOI: 10.1080/02688697.2016.1233316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander Antoniadis
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Nils H. Ulrich
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Samuel Schmid
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Kan Min
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
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Preoperative Predictors of Spinal Infection within the National Surgical Quality Inpatient Database. World Neurosurg 2016; 89:517-24. [DOI: 10.1016/j.wneu.2015.12.085] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 11/24/2022]
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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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Epidemiology of Surgical Site Infection in a Community Hospital Network. Infect Control Hosp Epidemiol 2016; 37:519-26. [PMID: 26864617 DOI: 10.1017/ice.2016.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To describe the epidemiology of complex surgical site infection (SSI) following commonly performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates over time for MRSA and other common pathogens METHODS We prospectively collected SSI data at 29 community hospitals in the southeastern United States from 2008 through 2012. We determined the overall prevalence rates of SSI for commonly performed procedures during this 5-year study period. For each year of the study, we then calculated prevalence rates of SSI stratified by causative organism. We created log-binomial regression models to analyze trends of SSI prevalence over time for all pathogens combined and specifically for MRSA. RESULTS A total of 3,988 complex SSIs occurred following 532,694 procedures (prevalence rate, 0.7 infections per 100 procedures). SSIs occurred most frequently after small bowel surgery, peripheral vascular bypass surgery, and colon surgery. Staphylococcus aureus was the most common pathogen. The prevalence rate of SSI decreased from 0.76 infections per 100 procedures in 2008 to 0.69 infections per 100 procedures in 2012 (prevalence rate ratio [PRR], 0.90; 95% confidence interval [CI], 0.82-1.00). A more substantial decrease in MRSA SSI (PRR, 0.69; 95% CI, 0.54-0.89) was largely responsible for this overall trend. CONCLUSIONS The prevalence of MRSA SSI decreased from 2008 to 2012 in our network of community hospitals. This decrease in MRSA SSI prevalence led to an overall decrease in SSI prevalence over the study period.
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Deep surgical site infection after anterior decompression and fusion with plate fixation for cervical spondylotic radiculopathy or myelopathy. Clin Neurol Neurosurg 2016; 141:13-8. [DOI: 10.1016/j.clineuro.2015.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 11/21/2022]
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Pereira BJ, de Holanda CVM, Ribeiro CA, Holanda LF, Cabral CD, Caravalho LL, de Oliveira JG. Spinal surgery for degenerative lumbar spine disease: Predictors of outcome. Clin Neurol Neurosurg 2016; 140:1-5. [DOI: 10.1016/j.clineuro.2015.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/29/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
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Dhurandhar NV, Bailey D, Thomas D. Interaction of obesity and infections. Obes Rev 2015; 16:1017-29. [PMID: 26354800 DOI: 10.1111/obr.12320] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
There is evidence that certain infections may induce obesity. Obese persons may also have more severe infections and have compromised response to therapies. The objective of this study is to review the available literature identifying infections that potentially contribute to greater body mass index (BMI) and differential responses of overweight and obese persons to infections. A systematic literature review of human studies examining associations between infections and weight gain, differential susceptibility, severity, and response to prevention and treatment of infection according to BMI status (January 1980-July 2014) was conducted. Three hundred and forty-three studies were eligible for inclusion. Evidence indicated that viral infection by human adenovirus Ad36 and antibiotic eradication of Helicobacter pylori were followed by weight gain. People who were overweight or obese had higher susceptibility to developing post-surgical infections, H1N1 influenza and periodontal disease. More severe infections tended to be present in people with a larger BMI. People with a higher BMI had a reduced response to vaccinations and antimicrobial drugs. Higher doses of antibiotics were more effective in obese patients. Infections may influence BMI, and BMI status may influence response to certain infections, as well as to preventive and treatment measures. These observations have potential clinical implications.
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Affiliation(s)
- N V Dhurandhar
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Bailey
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Thomas
- Center for Quantitative Obesity Research, Department of Mathematical Sciences, Montclair State University, Montclair, NJ, USA
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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: 7.0] [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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Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2015; 37:88-99. [PMID: 26503187 DOI: 10.1017/ice.2015.249] [Citation(s) in RCA: 381] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the independent association between diabetes and surgical site infection (SSI) across multiple surgical procedures. DESIGN Systematic review and meta-analysis. METHODS Studies indexed in PubMed published between December 1985 and through July 2015 were identified through the search terms "risk factors" or "glucose" and "surgical site infection." A total of 3,631 abstracts were identified through the initial search terms. Full texts were reviewed for 522 articles. Of these, 94 articles met the criteria for inclusion. Standardized data collection forms were used to extract study-specific estimates for diabetes, blood glucose levels, and body mass index (BMI). A random-effects meta-analysis was used to generate pooled estimates, and meta-regression was used to evaluate specific hypothesized sources of heterogeneity. RESULTS The primary outcome was SSI, as defined by the Centers for Disease Control and Prevention surveillance criteria. The overall effect size for the association between diabetes and SSI was odds ratio (OR)=1.53 (95% predictive interval [PI], 1.11-2.12; I2, 57.2%). SSI class, study design, or patient BMI did not significantly impact study results in a meta-regression model. The association was higher for cardiac surgery 2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001). CONCLUSIONS These results support the consideration of diabetes as an independent risk factor for SSIs for multiple surgical procedure types. Continued efforts are needed to improve surgical outcomes for diabetic patients. Infect. Control Hosp. Epidemiol. 2015;37(1):88-99.
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Schoenfeld AJ, Reamer EN, Wynkoop EI, Choi H, Bono CM. Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review. Clin Orthop Relat Res 2015; 473:2479-86. [PMID: 25518806 PMCID: PMC4488194 DOI: 10.1007/s11999-014-4102-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue. QUESTIONS/PURPOSES We performed a systematic review to address two questions: (1) Does sex (male versus female) influence mortality after spine surgery? (2) Does sex impact the development of postoperative complications after spine surgery? METHODS This systematic review was performed through a query of PubMed using a structured search algorithm. Additional queries of Embase, SCOPUS, Web of Science, and the tables of contents of orthopaedic and neurosurgical journals were also conducted using search terms such as "sex factors", "male or female", "risk factors", and "spine surgery". Selected papers were independently abstracted by three of the authors (AJS, ENR, EIW) and pooling was performed. Our literature search returned 720 studies, of which 99 underwent full review. Of these, 50 were selected for final abstraction. The Cochrane Q test was used to assess study heterogeneity; significant study heterogeneity was present and so a random-effects model was used. A Harbord test was used to evaluate for the presence of publication bias; this analysis found no statistically significant evidence of publication bias. RESULTS Males were at increased odds of mortality after spine surgery (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.35-1.97; p<0.001). No differences between the sexes were identified for the odds of complications (OR, 1.04; 95% CI, 0.95-1.13; p=0.42). CONCLUSIONS Our results determined that males were at elevated odds of mortality but not of complications after spine surgery. These results should be used to inform preoperative discussion and decision-making at the time of surgical consent. Future work should be directed at determining the underlying factors responsible for increased mortality among males and prospective studies specifically designed to evaluate sex-based differences in outcomes after spine surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor Veterans Administration Hospital, 2800 Plymouth Road, Building 10, RM G016, Ann Arbor, MI, 48109, USA,
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