Background: Surgical site infections are not uncommon following spinal operations, and they can be associated with serious morbidity, mortality, and increased resource utilization. The accurate identification of risk factors is essential to develop strategies to prevent these potentially devastating infections. We conducted a case-control study to determine independent risk factors for surgical site infection following orthopaedic spinal operations.

Methods: We performed a retrospective case-control study of patients who had had an orthopaedic spinal operation performed at a university-affiliated tertiary-care hospital from 1998 to 2002. Forty-six patients with a superficial, deep, or organ-space surgical site infection were identified and compared with 227 uninfected control patients. Risk factors for surgical site infection were determined with univariate analyses and multivariate logistic regression.

Results: The overall rate of spinal surgical site infection during the five years of the study was 2.0% (forty-six of 2316). Univariate analyses showed serum glucose levels, preoperatively and within five days after the operation, to be significantly higher in patients in whom surgical site infection developed than in uninfected control patients. Independent risk factors for surgical site infection that were identified by multivariate analysis were diabetes (odds ratio = 3.5, 95% confidence interval = 1.2, 10.0), suboptimal timing of prophylactic antibiotic therapy (odds ratio = 3.4, 95% confidence interval = 1.5, 7.9), a preoperative serum glucose level of >125 mg/dL (>6.9 mmol/L) or a postoperative serum glucose level of >200 mg/dL (>11.1 mmol/L) (odds ratio = 3.3, 95% confidence interval = 1.4, 7.5), obesity (odds ratio = 2.2, 95% confidence interval = 1.1, 4.7), and two or more surgical residents participating in the operative procedure (odds ratio = 2.2, 95% confidence interval = 1.0, 4.7). A decreased risk of surgical site infection was associated with operations involving the cervical spine (odds ratio = 0.3, 95% confidence interval = 0.1, 0.6).

Conclusions: Diabetes was associated with the highest independent risk of spinal surgical site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of surgical site infection. The role of hyperglycemia as a risk factor for surgical site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

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Risk factors for surgical site infection following orthopaedic spinal operations.

Object. The objective of this study was to identify specific independent risk factors for surgical site infections (SSIs) occurring after laminectomy or spinal fusion. Methods. The authors performed a retrospective case-control study of data obtained in patients between 1996 and 1999 who had undergone laminectomy and/or spinal fusion. Forty-one patients with SSI or meningitis were identified, and data were compared with those acquired in 178 uninfected control patients. Risk factors for SSI were determined using univariate analyses and multivariate logistic regression. The spinal surgery—related SSI rate (incisional and organ space) during the 4-year study period was 2.8%. Independent risk factors for SSI identified by multivariate analysis were postoperative incontinence (odds ratio [OR] 8.2, 95% confidence interval [CI] 2.9–22.8), posterior approach (OR 8.2, 95% CI 2–33.5), procedure for tumor resection (OR 6.2, 95% CI 1.7–22.3), and morbid obesity (OR 5.2, 95% CI 1.9–14.2). In patients with SSI the pos...

Risk factors for surgical site infection in spinal surgery

This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed.

A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys.

A survey was conducted to examine the source of information and usage of nutritional supplements in 115 male and 88 female varsity athletes at a Division I university. The survey asked each athlete to define supplement, and report supplement use and type, source of information, and reasons for use. Supplement use frequencies were determined, and comparisons were made between gender and sport. Eighty-nine percent of the subjects had or were currently using nutritional supplements. Many athletes did not consider sports drinks and calorie replacement products as supplements. Females were more likely to take calcium and multivitamins, and males had significant intake for ginseng, amino acids, glutamine, hydroxy-methyl-buterate (HMB), weight gainers, whey protein, and Juven. The most frequently used supplements overall were energy drinks (73%), calorie replacement products of all types (61.4%), multivitamin (47.3%), creatine (37.2%), and vitamin C (32.4%). There was also significant supplement use noted per sp...

Nutritional supplement use among college athletes and their sources of information.

STUDY DESIGN: A retrospective cohort study from a single institution of a consecutive series of spine surgery patients. OBJECTIVE: To evaluate the safety and efficacy of adjunctive local application of vancomycin for infection prophylaxis in posterior instrumented thoracic and lumbar spine wounds compared to IV cephalexin alone. SUMMARY OF BACKGROUND DATA: Cephalosporin resistant strains of staphylococcus (MRSA and coagulase negative staph) have diminished the efficacy of intravenous antibiotic prophylaxis for instrumented spine fusion. Intravenous vancomycin prophylaxis has not been shown to decrease wound infection rates compared to IV cephalosporins. Adjunctive application of vancomycin powder in wounds for instrumented spinal fusion surgery may decrease infection rates. METHODS: Since 2000, 1732 consecutive thoracic and lumbar posterior instrumented spinal fusions have been performed with routine 24 hours of perioperative intravenous antibiotic prophylaxis with cephalexin. Since 2006, 911 of these instrumented thoracic and lumbar cases had 2 g of vancomycin powder applied to the wound before closure in addition to intravenous antibiotics. A retrospective review for infection rates and complications was performed. Oswestry and SF-36 outcomes instruments were completed before surgery, immediately after surgery, and at latest follow-up. The average follow-up is 2.5 years, range 1 to 7 years. RESULTS: Eight hundred twenty-one posterior instrumented thoracic and lumbar fusions were preformed using intravenous cephalexin prophylaxis with a total of 21 deep wound infections (2.6%). Coag negative staph was the most commonly isolated organism. Nine hundred eleven posterior instrumented thoracic and lumbar fusions have been performed with IV cephalexin plus adjunctive local vancomycin powder with two deep wound infections (0.2%). The reduction in wound infections was statistically significant (P < 0.0001). There were no adverse clinical outcomes or wound complications related to the local application of vancomycin. CONCLUSION: Adjunctive local application of vancomycin powder decreases the postsurgical wound infection rate with statistical significance in posterior instrumented thoracolumbar spine fusions.

Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes

BACKGROUND Studies have shown postoperative infection rates increase with the use of internal instrumentation. It is believed that longer operative times, prolonged retraction, instrumentation, and bone grafting lead to a higher risk of infection. METHODS We retrospectively reviewed 126 consecutive instrumented lumbar fusions. All had bone graft. The infection rate was statistically compared with previously reported values. RESULTS Our infection rate (0.8%) was lower than the combined data from the literature (2.8%), though not significantly different. No significant differences were noted regarding patient or surgical factors. CONCLUSIONS This review showed that low rates of postoperative infection can be achieved despite patient or surgical factors. We believe that conforming to strict techniques, including copious irrigation and debridement, and having experienced operating room personnel and short operating times will reduce the incidence of postoperative infections.

Low Postoperative Infection Rates With Instrumented Lumbar Fusion

Background. Competitive athletes, including adolescents, seek ways to gain advantage over competitors. One ergogenic aid is creatine, a naturally occurring nitrogen compound found primarily in skeletal muscle. Increasing creatine levels may prolong skeletal muscle activity, enhancing work output. Methods. A questionnaire assessing awareness and use of creatine supplementation was completed by 674 athletes from 11 high schools. Data were statistically analyzed to determine variation among groups. Results. Of those surveyed, 75% had knowledge of creatine supplements, and 16% used creatine to enhance athletic performance. Percentage of use increased with age and grade level. Awareness and use were greater among boys than girls. Adverse effects were reported by 26%. Most athletes consumed creatine using a method inconsistent with scientific recommendations. Conclusions. Use of creatine by adolescent athletes is significant and inconsistent with optimal dosing. Physicians, athletic trainers, and coaches should disseminate proper information and advise these adolescent athletes.

Use of oral creatine as an ergogenic aid for increased sports performance: perceptions of adolescent athletes.

A modified technique for anterior multilevel cervical fusion

https://knowledge.e.southern.edu/cgi/viewcontent.cgi?article=1075&context=senior_research

Laurie A. Covington

Papers

Low Postoperative Infection Rates With Instrumented Lumbar Fusion

Use of oral creatine as an ergogenic aid for increased sports performance: perceptions of adolescent athletes.

A modified technique for anterior multilevel cervical fusion

The Chattanooga Procedure: A New Technique Used for Anterior Multi-level Cervical Fusions