Evaluating the Risk of Postoperative Infection and Complications in Lumbar Spine Surgery Patients with Preoperative Methicillin-resistant Staphylococcus aureus (MRSA) Colonization.

INTRODUCTION

Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections (SSIs) in orthopaedic procedures. However, its impact on a comprehensive range of postoperative complications, particularly in elective lumbar spine surgery (LSS), remains unexplored. This study evaluated the association between preoperative MRSA colonization and a comprehensive set of 30-day postoperative outcomes in patients undergoing LSS.

MATERIALS AND METHODS

A retrospective cohort study was conducted using the TriNetX multi-institutional database, including 440,336 patients undergoing elective LSS. Patients were stratified into MRSA-colonized (n = 3,711; 0.84%) and non-colonized controls (n = 436,625). Propensity score matching (1:1) adjusted for demographics and comorbidities (age, race, sex, obesity, diabetes, tobacco use, malnutrition, chronic kidney disease), yielding balanced cohorts of 3,706 patients each. Primary outcomes included 30-day mortality, SSIs, systemic infections (sepsis, pneumonia), hematologic complications (anemia, transfusions), renal failure, and thromboembolic events. Risk ratios (RR) with 95% confidence intervals were calculated.

RESULTS

MRSA-colonized patients exhibited significantly higher complication risks versus matched controls: Wound complications: superficial SSI (RR = 2.291, p < 0.01), deep SSI (RR = 2.566, p < 0.01), wound dehiscence (RR = 1.722, p < 0.01). Systemic Infections: sepsis (RR = 2.865, p < 0.001), pneumonia (RR = 2.212, p < 0.001). Hematologic/renal events: transfusion (RR = 2.382, p < 0.001), anemia (RR = 2.826, p < 0.001), acute kidney failure (RR = 2.344, p < 0.001).

MORTALITY

all-cause mortality was 2.05-fold higher (RR = 2.046, p < 0.01). Demographic analysis identified five major risk factors: obesity, diabetes, tobacco use, malnutrition, and chronic kidney disease (CKD) as independent predictors of MRSA colonization.

CONCLUSIONS

Preoperative MRSA colonization is independently associated with significantly elevated risks of mortality, wound complications, systemic infections, hematologic morbidity, and acute renal injury after elective LSS. Clinically, preoperative recognition of MRSA colonization could prompt implementation of multimodal decolonization protocols and targeted counseling regarding heightened complication risks. This risk-stratified approach may optimize perioperative management and improve outcomes in high-risk LSS patients.