Reduction of Instrumentation-Related Spine Surgical Site Infections After Optimization of Surgical Techniques. A Single Center Retrospective Analysis

• Published in: Global spine journal Vol. 14; no. 2; pp. 438 - 446
• Main Authors: San-Juan, Rafael, Paredes, Igor, Ramírez-Nava, Esther, Delgado-Fernández, Juan, Panero, Irene, Hernández-Ortiz, Paula, Ramírez-Vicente, Elia, Fernández-Ruiz, Mario, López-Medrano, Francisco, Corbella, Laura, Rodríguez-Goncer, Isabel, Brañas, Patricia, Lagares, Alfonso, Aguado, José María
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-03-2024; Sage Publications Ltd
• Subjects: Back surgery; Multivariate analysis; Original; Surgical site infections; Surgical techniques; Vertebrae; infection; spine; optimization of surgical techniques; instrumentation; risk factor
• ISSN: 2192-5682; 2192-5690
• DOI: 10.1177/21925682221109557

Study Design
Retrospective cohort study.
Objective
Although surgical risk factors for developing spine surgical site infections (S-SSI) have been identified, the impact of such knowledge in its prevention has not been demonstrated.
Methods
We evaluated in 500 patients undergoing spine surgery between 2011 and 2019 at Hospital 12 de Octubre the changes in S-SSI rates over time. Surgical variables independently related to S-SSI were analyzed by univariate and multivariate analysis using binary logistic regression models. A case-control sub-analysis (1:4), matched by the surgical variables identified in the overall cohort was also performed.
Results
Twenty cases of S-SSI were identified (4%), with a significant decrease in the incidence rate across consecutive time periods (6.6% [2011-2014] vs .86% [2015-2019]; P-value <.0001)). Multivariate analysis identified arthrodesis involving sacral levels (odds ratio [OR]: 2.57; 95% confidence interval [95%CI]: 1.02-6.47; P-value = .044) and instrumentation over 4-8 vertebrae (OR: 2.82; 95%CI: 1.1-7.1; P-value = .027) as independent risk factors for S-SSI. The reduction in the incidence of S-SSI concurred temporally with a reduction in instrumentations involving 4-8 vertebrae (55% vs 21.8%; P-value <.0001) and sacral vertebrae (46.9% vs 24.6%; P-value <.0001) across both periods. The case-control analysis matched by these surgical variables failed to identify other factors independently related to the occurrence of S-SSI.
Conclusions
Spinal fusion of more than 4 levels and the inclusion of sacral levels were independently related to the risk of S-SSI. Optimization of surgical techniques by reducing these two types of instrumentation could significantly reduce S-SSI rates.