Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Spine (Phila Pa 1976). 2021 May 1;46(9):624-629. doi: 10.1097/BRS.0000000000003904.
Retrospective case series.
We sought to identify risk factors associated with surgical site infection (SSI) after posterior long segment spinal fusion (PLSF).
Patients who undergo PLSF may be at elevated risk of SSI. Identifying factors associated with SSI in these operations can help risk stratify patients and tailor management.
We analyzed PLSFs-seven or more levels-at our institution from 2000 to 2015. Data on patients' clinical characteristics, procedural factors, and antimicrobial management were collected. Multivariable analysis identified factors independently associated with outcomes of interest.
In 628 cases, SSI was associated with steroid use (P = 0.024, odds ratio [OR] = 2.54) and using cefazolin (P < 0.001, OR = 4.37) or bacitracin (P = 0.010, OR 3.49) irrigation, as opposed to gentamicin or other irrigation. Gram-positive infections were more likely with staged procedures (P = 0.021, OR 4.91) and bacitracin irrigation (P < 0.001, OR = 17.98), and less likely with vancomycin powder (P = 0.050, OR 0.20). Gram-negative infections were more likely with a history of peripheral arterial disease (P = 0.034, OR = 3.21) or cefazolin irrigation (P < 0.001, OR 25.47). Readmission was more likely after staged procedures (P = 0.003, OR = 3.31), cervical spine surgery (P = 0.023, OR = 2.28), or cefazolin irrigation (P = 0.039, OR = 1.85). Reoperation was more common with more comorbidities (P = 0.022, OR 1.09), staged procedures (P < 0.001, OR = 4.72), cervical surgeries (P = 0.013, OR = 2.36), more participants in the surgery (P = 0.011, OR = 1.06), using cefazolin (P < 0.001, OR = 3.12) or bacitracin (P = 0.009, OR = 3.15) irrigation, and higher erythrocyte sedimentation rate at readmission (P = 0.009, OR = 1.04). Washouts were more likely among patients with more comorbidities (P = 0.013, OR = 1.16), or who used steroids (P = 0.022, OR = 2.92), and less likely after cervical surgery (P = 0.028, OR = 0.24). Instrumentation removal was more common with bacitracin irrigation (p = 0.013, OR = 31.76).
Patient factors, whether a procedure is staged, and choice of antibiotic irrigation affect the risk of SSI and ensuing management required.Level of Evidence: 4.
回顾性病例系列研究。
我们旨在确定与后路长节段脊柱融合术（PLSF）后手术部位感染（SSI）相关的危险因素。
接受 PLSF 的患者可能有较高的 SSI 风险。确定这些手术中与 SSI 相关的因素有助于对患者进行风险分层并进行管理。
我们分析了我院 2000 年至 2015 年的 7 个或更多节段的 PLSF。收集患者临床特征、手术因素和抗菌药物管理的数据。多变量分析确定与研究结果相关的独立危险因素。
在 628 例病例中，类固醇的使用（P=0.024，比值比[OR]=2.54）和使用头孢唑林（P<0.001，OR=4.37）或杆菌肽（P=0.010，OR=3.49）冲洗而不是庆大霉素或其他冲洗与 SSI 相关。分期手术（P=0.021，OR=4.91）和杆菌肽冲洗（P<0.001，OR=17.98）更可能导致革兰氏阳性感染，万古霉素粉末（P=0.050，OR=0.20）更可能降低革兰氏阳性感染的风险。有外周动脉疾病病史（P=0.034，OR=3.21）或头孢唑林冲洗史（P<0.001，OR=25.47）更可能导致革兰氏阴性感染。分期手术（P=0.003，OR=3.31）、颈椎手术（P=0.023，OR=2.28）或头孢唑林冲洗（P=0.039，OR=1.85）后更可能再次入院。合并症越多（P=0.022，OR=1.09）、分期手术（P<0.001，OR=4.72）、颈椎手术（P=0.013，OR=2.36）、手术参与者越多（P=0.011，OR=1.06）、使用头孢唑林（P<0.001，OR=3.12）或杆菌肽（P=0.009，OR=3.15）冲洗、以及再次入院时红细胞沉降率越高（P=0.009，OR=1.04），再次手术的可能性更大。合并症较多（P=0.013，OR=1.16）或使用类固醇（P=0.022，OR=2.92）的患者更容易进行冲洗。颈椎手术后冲洗的可能性较小（P=0.028，OR=0.24）。杆菌肽冲洗（P=0.013，OR=31.76）更可能导致器械移除。
患者因素、手术是否分期以及抗生素冲洗的选择会影响 SSI 的风险和随之而来的管理要求。
4 级。
