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Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study

Published online by Cambridge University Press:  19 December 2016

Thomas L. Walsh*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Ashley M. Querry
Affiliation:
Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Sheila McCool
Affiliation:
Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Alison L. Galdys
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Kathleen A. Shutt
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
Melissa I. Saul
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Carlene A. Muto
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
*
Address correspondence to Thomas L. Walsh, MD, Division of Infectious Diseases, Allegheny General Hospital, 320 East North Avenue, 4th Floor East Wing, Suite 406, Pittsburgh, PA 15136 (twalsh@wpahs.org).

Abstract

OBJECTIVE

To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion.

DESIGN

Retrospective case-control study.

SETTING

Large, academic, quaternary care center.

PATIENTS

The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI.

METHODS

To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls.

RESULTS

During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78).

CONCLUSIONS

In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion.

Infect Control Hosp Epidemiol 2017;38:348–352

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

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