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- Title
Reduction of Instrumentation-Related Spine Surgical Site Infections After Optimization of Surgical Techniques. A Single Center Retrospective Analysis.
- Authors
San-Juan, Rafael; Paredes, Igor; Ramírez-Nava, Esther; Delgado-Fernández, Juan; Panero, Irene; Hernández-Ortiz, Paula; Ramírez-Vicente, Elia; Fernández-Ruiz, Mario; López-Medrano, Francisco; Corbella, Laura; Rodríguez-Goncer, Isabel; Brañas, Patricia; Lagares, Alfonso; Aguado, José María
- Abstract
Study Design: Retrospective cohort study. Objective: Although surgical risk factors for developing spine surgical site infections (S-SSI) have been identified, the impact of such knowledge in its prevention has not been demonstrated. Methods: We evaluated in 500 patients undergoing spine surgery between 2011 and 2019 at Hospital 12 de Octubre the changes in S-SSI rates over time. Surgical variables independently related to S-SSI were analyzed by univariate and multivariate analysis using binary logistic regression models. A case-control sub-analysis (1:4), matched by the surgical variables identified in the overall cohort was also performed. Results: Twenty cases of S-SSI were identified (4%), with a significant decrease in the incidence rate across consecutive time periods (6.6% [2011-2014] vs.86% [2015-2019]; P -value <.0001)). Multivariate analysis identified arthrodesis involving sacral levels (odds ratio [OR]: 2.57; 95% confidence interval [95%CI]: 1.02-6.47; P- value =.044) and instrumentation over 4-8 vertebrae (OR: 2.82; 95%CI: 1.1-7.1; P- value =.027) as independent risk factors for S-SSI. The reduction in the incidence of S-SSI concurred temporally with a reduction in instrumentations involving 4-8 vertebrae (55% vs 21.8%; P- value <.0001) and sacral vertebrae (46.9% vs 24.6%; P -value <.0001) across both periods. The case-control analysis matched by these surgical variables failed to identify other factors independently related to the occurrence of S-SSI. Conclusions: Spinal fusion of more than 4 levels and the inclusion of sacral levels were independently related to the risk of S-SSI. Optimization of surgical techniques by reducing these two types of instrumentation could significantly reduce S-SSI rates.
- Subjects
SURGICAL site infections; OPERATIVE surgery; MATHEMATICAL optimization; PREOPERATIVE risk factors; SACRUM; SPINAL surgery
- Publication
Global Spine Journal, 2024, Vol 14, Issue 2, p438
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/21925682221109557