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Scientific Articles   |    
Risk Factors for Postoperative Infection Following Posterior Lumbar Instrumented Arthrodesis
Stelios Koutsoumbelis, MD1; Alexander P. Hughes, MD1; Federico P. Girardi, MD1; Frank P. Cammisa, Jr, MD1; Eileen A. Finerty, MS, RN1; Joseph T. Nguyen, MPH1; Elizabeth Gausden, BS2; Andrew A. Sama, MD1
1 Spine Surgery Service, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for A.P. Hughes: hughesa@hss.edu
2 Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Investigation performed at the Spine Surgery Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Sep 07;93(17):1627-1633. doi: 10.2106/JBJS.J.00039
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Abstract

Background: 

Surgical site infection in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment, and estimated blood loss are well established in the literature to affect the risk of infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among spine patients undergoing posterior lumbar instrumented arthrodesis.

Methods: 

The medical records of 3218 patients who underwent posterior lumbar instrumented arthrodesis from January 2000 to December 2006 were reviewed to identify those who developed a postoperative infection (eighty-four patients; 2.6%). The size of this single-institution patient group allowed construction of a multivariate logistic regression model to evaluate the independent associations of potential risk factors for surgical site infection in the spine.

Results: 

In the final regression model, obesity, estimated intraoperative blood loss, ten or more people in the operating room, a dural tear, history of diabetes, chronic obstructive pulmonary disease, coronary heart disease, and osteoporosis were critical risk factors for the onset of spinal surgical site infection. Obesity and a history of chronic obstructive pulmonary disease were the strongest risk factors for postoperative spinal infection after adjusting for all other variables. The most common pathogen was methicillin-resistant Staphylococcus aureus with a prevalence of 34.5%. This study established a single institution infection rate for posterior lumbar instrumented arthrodesis at 2.6%.

Conclusions: 

This analysis confirms previously demonstrated risk factors for postoperative infection while reporting on new potential independent risk factors of osteoporosis, chronic obstructive pulmonary disease, and dural tears in the setting of posterior lumbar instrumented arthrodesis. Areas of new research can focus on the roles these novel factors may play in the pathogenesis of surgical site infections in the spine.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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