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Review
. 2017 May/Jun;18(4):461-473.
doi: 10.1089/sur.2016.186. Epub 2016 Nov 30.

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement of Staphylococcus aureus

Harshila Patel  1 , Hanane Khoury  1 , Douglas Girgenti  2 , Sharon Welner  1 , Holly Yu  3
Affiliations
Review

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement of Staphylococcus aureus

Harshila Patel et al. Surg Infect (Larchmt). 2017 May/Jun.

Abstract

Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.

Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.

Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%-22.6%) and 1.0% (median, 2.0%; range, 0.02%-10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%-100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%-100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%-2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%-100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.

Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

Keywords: Staphylococcus aureus; decompression; instrumentation; spinal fusion; spine operations; surgical site infection.

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Conflict of interest statement

At the time of writing, Drs. Patel, Khoury, and Welner were employees of LASER Analytica, who were paid consultants to Pfizer, Inc. in connection with performing the literature review study and developing the manuscript. Ms. Yu and Dr. Girgenti were employees of Pfizer, Inc.

Figures

<b>FIG. 1.</b>
FIG. 1.
PRISMA diagram.
<b>FIG. 2.</b>
FIG. 2.
Pooled average surgical site infection (SSI) rates according to category of spine surgery.
<b>FIG. 3.</b>
FIG. 3.
Mean length of stay for patients who underwent spine operations of interest and did or did not develop surgical site infections.
<b>FIG. 4.</b>
FIG. 4.
Pooled average re-operation rates caused by surgical site infection (SSI) among patients who underwent select spine operations and developed SSIs.
See this image and copyright information in PMC

References

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