Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012

Arjun Sebastian, Paul Huddleston, Sanjeev Kakar, Elizabeth B Habermann, Amy Wagie, Ahmad Nassr

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

BACKGROUND CONTEXT: The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18% in the literature. Few large studies have specifically examined posterior cervical procedures.

PURPOSE: The study aims to examine the incidence, timing, and risk factors for SSI following posterior cervical surgery.

DESIGN: This is a retrospective cohort study of prospectively collected data in a national surgical outcomes database.

PATIENT SAMPLE: The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Data File.

OUTCOME MEASURES: The 30-day rate of postoperative SSI, timing of diagnosis, and associated risk factors were determined.

METHODS: The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012. Thirty-day readmission data were obtained for 2011-2012. The incidence and timing of SSI were determined. Multivariable logistic regression analysis was then performed to identify significant risk factors.

RESULTS: Of the 5,441 patients identified as having undergone posterior cervical surgery, 3,724 had a posterior cervical decompression, 1,310 had a posterior cervical fusion, and 407 underwent cervical laminoplasty. Surgical site infection within 30 days was identified in 160 patients (2.94%), with 80 of those cases being superficial SSI. There was no significant difference in SSI rate among the three procedure groups. The average time for diagnosis of SSI was over 2 weeks. In 2011-2012, 36.9% of patients with SSI were readmitted within 30 days. Several significant predictors of SSI were identified in univariate analysis, including body mass index (BMI) >35, chronic steroid use, albumin <3, hematocrit <33, platelets <100, higher American Society of Anesthesiologists class, longer operative time, and longer hospital admission. Independent risk factors, including BMI >35 (odds ratio [OR]=1.78, p=.003), chronic steroid use (OR=1.73, p=.049), and operative time >197 minutes (OR=2.08, p=.005), were identified in multivariable analysis.

CONCLUSIONS: Optimization of preoperative nutritional status, serum blood cell counts, and operative efficiency may lead to a reduction in SSI rates. Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk.

Original languageEnglish (US)
Pages (from-to)504-509
Number of pages6
JournalThe spine journal : official journal of the North American Spine Society
Volume16
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Surgical Wound Infection
Quality Improvement
Spine
Odds Ratio
Steroids
Surgeons
Incidence
Current Procedural Terminology
Blood Cell Count
Information Storage and Retrieval
Operative Time
Decompression
Nutritional Status
Albumins
Body Mass Index
Cohort Studies

Keywords

  • ACS-NSQIP
  • Cervical spine surgery
  • Obesity
  • Posterior cervical
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{c96245d024964729bf0a2b44d53369df,
title = "Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012",
abstract = "BACKGROUND CONTEXT: The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18{\%} in the literature. Few large studies have specifically examined posterior cervical procedures.PURPOSE: The study aims to examine the incidence, timing, and risk factors for SSI following posterior cervical surgery.DESIGN: This is a retrospective cohort study of prospectively collected data in a national surgical outcomes database.PATIENT SAMPLE: The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Data File.OUTCOME MEASURES: The 30-day rate of postoperative SSI, timing of diagnosis, and associated risk factors were determined.METHODS: The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012. Thirty-day readmission data were obtained for 2011-2012. The incidence and timing of SSI were determined. Multivariable logistic regression analysis was then performed to identify significant risk factors.RESULTS: Of the 5,441 patients identified as having undergone posterior cervical surgery, 3,724 had a posterior cervical decompression, 1,310 had a posterior cervical fusion, and 407 underwent cervical laminoplasty. Surgical site infection within 30 days was identified in 160 patients (2.94{\%}), with 80 of those cases being superficial SSI. There was no significant difference in SSI rate among the three procedure groups. The average time for diagnosis of SSI was over 2 weeks. In 2011-2012, 36.9{\%} of patients with SSI were readmitted within 30 days. Several significant predictors of SSI were identified in univariate analysis, including body mass index (BMI) >35, chronic steroid use, albumin <3, hematocrit <33, platelets <100, higher American Society of Anesthesiologists class, longer operative time, and longer hospital admission. Independent risk factors, including BMI >35 (odds ratio [OR]=1.78, p=.003), chronic steroid use (OR=1.73, p=.049), and operative time >197 minutes (OR=2.08, p=.005), were identified in multivariable analysis.CONCLUSIONS: Optimization of preoperative nutritional status, serum blood cell counts, and operative efficiency may lead to a reduction in SSI rates. Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk.",
keywords = "ACS-NSQIP, Cervical spine surgery, Obesity, Posterior cervical, Surgical site infection",
author = "Arjun Sebastian and Paul Huddleston and Sanjeev Kakar and Habermann, {Elizabeth B} and Amy Wagie and Ahmad Nassr",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.spinee.2015.12.009",
language = "English (US)",
volume = "16",
pages = "504--509",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Risk factors for surgical site infection after posterior cervical spine surgery

T2 - an analysis of 5,441 patients from the ACS NSQIP 2005-2012

AU - Sebastian, Arjun

AU - Huddleston, Paul

AU - Kakar, Sanjeev

AU - Habermann, Elizabeth B

AU - Wagie, Amy

AU - Nassr, Ahmad

PY - 2016/4/1

Y1 - 2016/4/1

N2 - BACKGROUND CONTEXT: The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18% in the literature. Few large studies have specifically examined posterior cervical procedures.PURPOSE: The study aims to examine the incidence, timing, and risk factors for SSI following posterior cervical surgery.DESIGN: This is a retrospective cohort study of prospectively collected data in a national surgical outcomes database.PATIENT SAMPLE: The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Data File.OUTCOME MEASURES: The 30-day rate of postoperative SSI, timing of diagnosis, and associated risk factors were determined.METHODS: The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012. Thirty-day readmission data were obtained for 2011-2012. The incidence and timing of SSI were determined. Multivariable logistic regression analysis was then performed to identify significant risk factors.RESULTS: Of the 5,441 patients identified as having undergone posterior cervical surgery, 3,724 had a posterior cervical decompression, 1,310 had a posterior cervical fusion, and 407 underwent cervical laminoplasty. Surgical site infection within 30 days was identified in 160 patients (2.94%), with 80 of those cases being superficial SSI. There was no significant difference in SSI rate among the three procedure groups. The average time for diagnosis of SSI was over 2 weeks. In 2011-2012, 36.9% of patients with SSI were readmitted within 30 days. Several significant predictors of SSI were identified in univariate analysis, including body mass index (BMI) >35, chronic steroid use, albumin <3, hematocrit <33, platelets <100, higher American Society of Anesthesiologists class, longer operative time, and longer hospital admission. Independent risk factors, including BMI >35 (odds ratio [OR]=1.78, p=.003), chronic steroid use (OR=1.73, p=.049), and operative time >197 minutes (OR=2.08, p=.005), were identified in multivariable analysis.CONCLUSIONS: Optimization of preoperative nutritional status, serum blood cell counts, and operative efficiency may lead to a reduction in SSI rates. Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk.

AB - BACKGROUND CONTEXT: The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18% in the literature. Few large studies have specifically examined posterior cervical procedures.PURPOSE: The study aims to examine the incidence, timing, and risk factors for SSI following posterior cervical surgery.DESIGN: This is a retrospective cohort study of prospectively collected data in a national surgical outcomes database.PATIENT SAMPLE: The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Data File.OUTCOME MEASURES: The 30-day rate of postoperative SSI, timing of diagnosis, and associated risk factors were determined.METHODS: The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012. Thirty-day readmission data were obtained for 2011-2012. The incidence and timing of SSI were determined. Multivariable logistic regression analysis was then performed to identify significant risk factors.RESULTS: Of the 5,441 patients identified as having undergone posterior cervical surgery, 3,724 had a posterior cervical decompression, 1,310 had a posterior cervical fusion, and 407 underwent cervical laminoplasty. Surgical site infection within 30 days was identified in 160 patients (2.94%), with 80 of those cases being superficial SSI. There was no significant difference in SSI rate among the three procedure groups. The average time for diagnosis of SSI was over 2 weeks. In 2011-2012, 36.9% of patients with SSI were readmitted within 30 days. Several significant predictors of SSI were identified in univariate analysis, including body mass index (BMI) >35, chronic steroid use, albumin <3, hematocrit <33, platelets <100, higher American Society of Anesthesiologists class, longer operative time, and longer hospital admission. Independent risk factors, including BMI >35 (odds ratio [OR]=1.78, p=.003), chronic steroid use (OR=1.73, p=.049), and operative time >197 minutes (OR=2.08, p=.005), were identified in multivariable analysis.CONCLUSIONS: Optimization of preoperative nutritional status, serum blood cell counts, and operative efficiency may lead to a reduction in SSI rates. Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk.

KW - ACS-NSQIP

KW - Cervical spine surgery

KW - Obesity

KW - Posterior cervical

KW - Surgical site infection

UR - http://www.scopus.com/inward/record.url?scp=84984868035&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84984868035&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2015.12.009

DO - 10.1016/j.spinee.2015.12.009

M3 - Article

C2 - 26686605

AN - SCOPUS:84984868035

VL - 16

SP - 504

EP - 509

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

IS - 4

ER -