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Invasiveness Index as a Predictor of Surgical Site Infection after Spinal Fusion, Revision Fusion, or Laminectomy

Published online by Cambridge University Press:  09 November 2016

Brian L. Hollenbeck
Affiliation:
Division of Infectious Diseases, New England Baptist Hospital, Boston, Massachusetts
Kevin J. McGuire
Affiliation:
Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, Massachusetts
Andrew P. White
Affiliation:
Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, Massachusetts
David S. Yassa
Affiliation:
Beth Israel Deaconess Medical Center, Division of Infection Control/ Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Boston, Massachusetts
Sharon B. Wright
Affiliation:
Beth Israel Deaconess Medical Center, Division of Infection Control/ Hospital Epidemiology, Silverman Institute for Health Care Quality and Safety, Boston, Massachusetts
Corresponding
E-mail address:

Abstract

OBJECTIVE

To evaluate invasiveness index as a potential predictor of spine surgical site infection (SSI) after spinal fusion, revision fusion, or laminectomy.

DESIGN

Retrospective cohort study.

SETTING

Single, large, academic medical center.

PATIENTS

Adults undergoing spinal fusion, revision fusion, or laminectomy.

METHODS

Data were obtained from electronic hospital databases; cases of SSI were extracted from the infection control database using National Healthcare Safety Network (NHSN) definitions. For each case, an invasiveness index, determined by surgical approach, procedure, and number of spine levels treated, was calculated using current procedural terminology (CPT) billing codes. Statistical analyses were performed using univariate and multivariate logistic regression models.

RESULTS

In total, 3,143 patients met inclusion criteria, and 43 of these developed SSI. Multivariate regression showed that advanced age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.005–1.05, for each year of life) and invasiveness index (medium invasiveness index OR, 5.36; 95% CI, 1.92–14.96; high invasiveness index OR, 14.1; 95% CI, 4.38–45.43) were significant predictors of infection. In subgroup analyses of spinal fusion patients, morbid obesity (OR, 2.542; 95% CI, 1.08–5.99), trauma (OR, 2.41; 95% CI, 1.05–5.55), and invasiveness index (medium invasiveness index OR, 5.39; 95% CI, 1.56–18.61; high invasiveness index OR, 13.44; 95% CI, 3.28–55.01) were significant predictors of SSI. Models containing invasiveness index were compared to NHSN models and demonstrated similar performance.

CONCLUSIONS

Invasiveness index is a predictor of SSI after spinal fusion and performs similarly to NHSN models. Invasiveness index shows promise as a potential risk stratification tool that is easily calculated and is available preoperatively.

Infect Control Hosp Epidemiol 2016:1–7

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These data were presented as an Abstract at IDWeek 2014 in Philadelphia, Pennsylvania, on October 10, 2014. EP 1009.

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