TY - JOUR
T1 - Postoperative Surgical Site Infection After Spine Surgery
T2 - An Update From the Scoliosis Research Society (SRS) Morbidity and Mortality Database*
AU - Shillingford, Jamal N.
AU - Laratta, Joseph L.
AU - Reddy, Hemant
AU - Ha, Alex
AU - Lehman, Ronald A.
AU - Lenke, Lawrence G.
AU - Fischer, Charla R.
N1 - Funding Information:
Author disclosures: JNS (none), JLL (none), HR (none), AH (none), RAL (grants from PRORP [Department of Defense Peer Reviewed Orthopaedic Research Program]; personal fees and nonfinancial support from DePuy Synthes Spine, Stryker, and Medtronic, outside the submitted work), LGL (other [board membership fees] from OREF and GSO, personal fees [for consultancy] from DePuy Synthes Spine, K2M, and Medtronic, personal fees [for expert testimony] from Fox Rothschild, LLP; grants from AOSpine, Scoliosis Research Society, DePuy Synthes Spine, Setting Scoliosis Straight Foundation, and EOS; other [royalties from patents] from Medtronic; personal fees [travel accommodations/meeting expenses] from AOSpine, Broadwater, Seattle Science Foundation, Scoliosis Research Society, and The Spinal Research Foundation; fellowship grant [Evnor] from AOSpine, North America; grants from [philanthropic research funding] Fox Family Foundation and Evans Family, outside the submitted work), CRF (none).
Publisher Copyright:
© 2018 Scoliosis Research Society
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Study Design: Retrospective review of prospectively collected data. Objective: Analyze the Scoliosis Research Society (SRS) Morbidity & Mortality (M&M) database to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after spinal deformity surgery. Summary of Background Data: Infections involving spinal instrumentation are associated with greater rates of disability. Rates of postoperative SSI after spinal deformity surgery range from 1.9% to 4.4%. Postoperative SSI rates of 4.2% for adult kyphosis, 2.1% for adult spondylolisthesis, and 3.7% for adult scoliosis have been reported. Methods: The SRS M&M database was evaluated to define patient demographics, perioperative factors, and infection characteristics of spinal deformity patients with postoperative spine infections after deformity surgery in 2012. Results: Of the 47,755 procedures reported to the SRS in 2012, there were 578 (1.2%) diagnosed SSIs. Infection rates for patients with kyphosis were significantly higher compared with patients with scoliosis (2.4% vs. 1.1%, p <.0001) or spondylolisthesis (2.4% vs. 1.1%, p <.0001). Spinal fusions were performed in 86.3% of patients, 75.1% of which were performed posteriorly. Osteotomies were performed in 30.1% of patients. Deep infections below the fascia accounted for 68.0% of infections. Methicillin-sensitive (41.9%) and methicillin-resistant (17.0%) Staphylococcus aureus were the most commonly isolated pathogens, whereas gram-negative bacteria accounted for 25.4% of cases. Long-term antibiotic suppression was required in 18.9% of patients, and overall complications from antibiotics occurred in 4.5% of patients. Operative treatment was required in 81.8% of SSI cases. Conclusion: SSIs occur in 1.2% of spine deformity patients, with a rate significantly higher in patients with kyphosis. Approximately 25% of these infections are secondary to gram-negative species. Antibiotic complications occur in 4.5% of patients being treated for SSI. Despite advancements in surgical technique and infection prophylaxis, postoperative SSI remains one of the most common complications in spinal deformity surgery.
AB - Study Design: Retrospective review of prospectively collected data. Objective: Analyze the Scoliosis Research Society (SRS) Morbidity & Mortality (M&M) database to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after spinal deformity surgery. Summary of Background Data: Infections involving spinal instrumentation are associated with greater rates of disability. Rates of postoperative SSI after spinal deformity surgery range from 1.9% to 4.4%. Postoperative SSI rates of 4.2% for adult kyphosis, 2.1% for adult spondylolisthesis, and 3.7% for adult scoliosis have been reported. Methods: The SRS M&M database was evaluated to define patient demographics, perioperative factors, and infection characteristics of spinal deformity patients with postoperative spine infections after deformity surgery in 2012. Results: Of the 47,755 procedures reported to the SRS in 2012, there were 578 (1.2%) diagnosed SSIs. Infection rates for patients with kyphosis were significantly higher compared with patients with scoliosis (2.4% vs. 1.1%, p <.0001) or spondylolisthesis (2.4% vs. 1.1%, p <.0001). Spinal fusions were performed in 86.3% of patients, 75.1% of which were performed posteriorly. Osteotomies were performed in 30.1% of patients. Deep infections below the fascia accounted for 68.0% of infections. Methicillin-sensitive (41.9%) and methicillin-resistant (17.0%) Staphylococcus aureus were the most commonly isolated pathogens, whereas gram-negative bacteria accounted for 25.4% of cases. Long-term antibiotic suppression was required in 18.9% of patients, and overall complications from antibiotics occurred in 4.5% of patients. Operative treatment was required in 81.8% of SSI cases. Conclusion: SSIs occur in 1.2% of spine deformity patients, with a rate significantly higher in patients with kyphosis. Approximately 25% of these infections are secondary to gram-negative species. Antibiotic complications occur in 4.5% of patients being treated for SSI. Despite advancements in surgical technique and infection prophylaxis, postoperative SSI remains one of the most common complications in spinal deformity surgery.
KW - Deformity
KW - Kyphosis
KW - Scoliosis Research Society
KW - Spine
KW - Surgical site infection
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U2 - 10.1016/j.jspd.2018.04.004
DO - 10.1016/j.jspd.2018.04.004
M3 - Article
C2 - 30348337
AN - SCOPUS:85049054173
SN - 2212-134X
VL - 6
SP - 634
EP - 643
JO - Spine deformity
JF - Spine deformity
IS - 6
ER -