55 - Incidence and Mortality of Surgical Site Infections after Cervical Spi...

#55 Incidence and Mortality of Surgical Site Infections after Cervical Spine Surgery

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: A surgical site infection (SSI) is one of the most common complications after spine surgery. In order to characterize the national burden of this complication, a population-based database was analyzed to identify incidences, risk factors and outcomes associated with SSIs following a cervical spine procedure.

Methods: Data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project was obtained for each year between 2002-2011. Patients undergoing anterior cervical fusion (ACF), posterior cervical fusion (PCF), and posterior cervical decompression (PCD) procedures for the diagnosis of cervical radiculopathy and myelopathy were identified. Incidences of SSI were also identified for each surgical approach and separated into cohorts. Patient demographics, comorbidities (CCI), LOS, costs and mortality were assessed. SPSS v.20 was utilized for statistical analysis with Independent-Samples T test for discrete variables, χ2 test for categorical data, and ANOVA tests for comparing means between the surgical cohorts. Binomial logistic regression was utilized to identify significant risk factors for a SSI. A p-value of ≤0.001 denoted statistical significance.

Results: There were 308,040 cervical spine procedures recorded in the NIS database from 2002-2011. The incidences of SSI in the PCF and PCD cohorts were significantly greater than in the ACF cohort (13.2 and 14.3 vs 2.5, p< 0,001). Overall, the SSI cohort demonstrated an increased comorbidity burden (3.67 vs. 2.31, p< 0.001), hospitalizations (14.7 vs. 2.3 days, p< 0.001) and costs ($39,050 vs. $13,390, p< 0.001). Logistic regression analysis demonstrated that significant risk factors for a SSI included emergent admissions, male gender, deficiency anemia, coagulopathy, drug abuse, liver failure, fluid/electrolyte disorders, weight loss, posterior approaches, and teaching hospital status. Lastly, a SSI was associated with a greater mortality rate (p< 0.001).

Conclusion: In our study, the national incidence of SSI was 4.4 per 1,000 cases in patients undergoing a cervical spine procedure. A posterior approach was a significant risk factor for a SSI. In addition, male patients undergoing a posterior cervical spine procedure with particular comorbidities (anemia, drug abuse, liver failure, etc.) were at an increased risk for a post-operative wound infection. Further studies should aim to mitigate these risk factors in an effort to improve postoperative outcomes following cervical spine surgery.

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