Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation

Clinical article

Masahiko Watanabe Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan

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Daisuke Sakai Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan

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Daisuke Matsuyama Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan

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Yukihiro Yamamoto Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan

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Masato Sato Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan

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Joji Mochida Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan

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Object

The purpose of this study was to identify risk factors for surgical site infection after spine surgery, noting the amount of saline used for intraoperative irrigation to minimize wound contamination.

Methods

The authors studied 223 consecutive spine operations from January 2006 through December 2006 at our institute. For a case to meet inclusion criteria as a site infection, it needed to require surgical incision and drainage and show positive intraoperative cultures. Preoperative and intraoperative data regarding each patient were collected. Patient characteristics recorded included age, sex, and body mass index (BMI). Preoperative risk factors included preoperative hospital stay, history of smoking, presence of diabetes, and an operation for a traumatized spine. Intraoperative factors that might have been risk factors for infection were collected and analyzed; these included type of procedure, estimated blood loss, duration of operation, and mean amount of saline used for irrigation per hour. Data were subjected to univariate and multivariate logistic regression analyses.

Results

The incidence of surgical site infection in this population was 6.3%. According to the univariate analysis, there was a significant difference in the mean duration of operation and intraoperative blood loss, but not in patient age, BMI, or preoperative hospital stay. The mean amount of saline used for irrigation in the infected group was less than in the noninfected group, but was not significantly different. In the multivariate analysis, sex, advanced age (> 60 years), smoking history, and obesity (BMI > 25 kg/m2) did not show significant differences. In the analysis of patient characteristics, only diabetes (patients receiving any medications or insulin therapy at the time of surgery) was independently associated with an increased risk of surgical site infection (OR 4.88). In the comparison of trauma and elective surgery, trauma showed a significant association with surgical site infection (OR 9.42). In the analysis of surgical factors, a sufficient amount of saline for irrigation (mean > 2000 ml/hour) showed a strong association with the prevention of surgical site infection (OR 0.08), but prolonged operation time (> 3 hours), high blood loss (> 300 g), and instrumentation were not associated with surgical site infection.

Conclusions

Diabetes, trauma, and insufficient intraoperative irrigation of the surgical wound were independent and direct risk factors for surgical site infection following spine surgery. To prevent surgical site infection in spine surgery, it is important to control the perioperative serum glucose levels in patients with diabetes, avoid any delay of surgery in patients with trauma, and decrease intraoperative contamination by irrigating > 2000 ml/hour of saline in all patients.

Abbreviation used in this paper:

BMI = body mass index.
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