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To The Editor: We have read with interest the retrospective case series by Gruskay et al.1 evaluating the hypothesized relation between seasonal factors and the occurrence of surgical site infections (SSIs) following spinal surgery (Gruskay J, Smith J, Kepler CK, et al: The seasonality of postoperative infection in spine surgery. Clinical article. J Neurosurg Spine 18:57–62, January 2013). The authors found a significantly higher rate of SSIs during the summer and fall months and considered the postulated hypothesis as being correct. We believe, however, that the reported conclusion should be

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Please include this information when citing this paper: published online April 19, 2013; DOI: 10.3171/2013.2.SPINE1386.

© AANS, except where prohibited by US copyright law.

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    Upper: Graph showing the infection rate on a monthly basis. A regression analysis resulted in a best-fit line that shows a statistically significant downward trend over the course of the academic year. Data derived from Gruskay et al.1 Lower: Re-analyzed graph of data presented in upper graph. A regression analysis resulted in a best-fit line that shows a statistically nonsignificant downward trend over the course of the seasons, starting in (northern hemisphere) summer months. Data derived from Gruskay et al.

References

1

Gruskay JSmith JKepler CKRadcliff KHarrop JAlbert T: The seasonality of postoperative infection in spine surgery. Clinical article. J Neurosurg Spine 18:57622013

2

Pull ter Gunne AFHosman AJCohen DBSchuetz Mvan Laarhoven CJvan Middendorp JJ: A methodological systematic review on surgical site infections following spinal surgery: part 1: risk factors. Spine (Phila Pa 1976) 37:201720332012

1

Banco SPVaccaro ARBlam OEck JCCotler JMHilibrand AS: Spine infections: variations in incidence during the academic year. Spine (Phila Pa 1976) 27:9629652002

2

Mermel LAMachan JTParenteau S: Seasonality of MRSA infections. PLoS One 6:e179252011

3

Perencevich ENMcGregor JCShardell MFuruno JPHarris ADMorris JG Jr: Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients. Infect Control Hosp Epidemiol 29:112411312008

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