Low, not no infection rate for spinal surgery

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A recently published retrospective review of a prospectively collected database, published in the 1 April issue of the journal Spine, has revealed estimates of how often wound infection occurs after spine surgery. The study analysed 108,419 cases. 

The study titled “Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee” set out to assess the rates of postoperative wound infection associated with spine surgery. The study also found that factors such as revision surgery, carrying out spinal fusion and the use of implants, are all associated with an increased rate of infection. It is important to recognise that these data do not necessarily suggest a causation link between infection and performance of fusion or inclusion of implants, but rather likely reflect greater complexity and associated risk for cases that require fusion or the use of implants.

 

Additionally, the study shows that a minimally invasive approach for lumbar discectomy and transforaminal lumbar interbody fusion scores over traditional open methods for these procedures as they result in significantly lower infection rates.


Authors Justin S Smith et al write that wound infection after spine surgery remains a common source of morbidity, yet estimates of its rates of occurrence remain relatively limited. They also explain that The Scoliosis Research Society prospectively collects morbidity and mortality data from its members including the occurrence of wound infection and that this research has been based on this database. 

 

Smith, assistant professor of Neurological Surgery and director, Minimally Invasive Spine Surgery, Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, USA, said:“Data from this study suggest that even among skilled spine surgeons, infection after spine surgery is an inherent potential complication. Our study provides a point of reference of infection rates as a basis for ongoing efforts to improve safety of care.”

 

Investigators queried the Scoliosis Research Society morbidity and mortality database for all reported spine surgery cases in a three-year period (2004–2007). They also distinguished between cases based on multiple factors such as diagnosis, adult (≥21 years) versus paediatric (<21 years), primary versus revision, use of implants, and whether a minimally invasive approach was used. They calculated superficial, deep, and total infection rates.

 

Results

  • 108,419 cases were identified with an overall total infection rate of 2.1%. There were 0.8% superficial infections and 1.3% deep ones.
  • Total postoperative wound infection rate for adults ranged from 1.4% for degenerative disease to 4.2% for kyphosis (Based on primary diagnosis)
  • Postoperative wound infection rates for paediatric patients ranged from 0.9% for degenerative disease to 5.4% for kyphosis.
  • Further stratification of the rates of the infection were based on subtype of degenerative disease, type of scoliosis, and type of kyphosis for both adult and paediatric patients.
  • Interestingly, the study showed that several features were linked to higher rates of infection. These were: revision surgery (p<0.001), performing spinal fusion (p<0.001), and use of implants (p<0.001).
  • Compared with a traditional open approach, use of a minimally invasive approach was associated with a lower rate of infection for lumbar discectomy (0.4% vs. 1.1%; p<0.001) and for transforaminal lumbar interbody fusion (1.3% vs. 2.9%; p=0.005).
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