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European Spine Journal

, Volume 22, Issue 8, pp 1854–1858 | Cite as

Predisposing factors for surgical site infection of spinal instrumentation surgery for diabetes patients

  • Kotaro SatakeEmail author
  • Tokumi Kanemura
  • Akiyuki Matsumoto
  • Hidetoshi Yamaguchi
  • Yoshimoto Ishikawa
Original Article

Abstract

Purpose

Diabetes mellitus (DM) is known as an important risk factor for surgical site infection (SSI) in spine surgery. It is still unclear however which DM-related parameters have stronger influence on SSI. The purpose of this study is to determine predisposing factors for SSI following spinal instrumentation surgery for patients with DM.

Methods

110 DM patients (66 males and 44 females) who underwent spinal instrumentation surgery in one institute were enrolled in this study. For each patient, various preoperative or intraoperative parameters were reviewed from medical records. Patients were divided into two groups (SSI or non-SSI) based on the postoperative course. Each parameter between these two groups was compared. Univariate and multivariate analyses were performed to determine predisposing factor for SSI.

Results

The SSI group consisted of 11 patients (10 %), and the non-SSI group of 99 patients (90 %). Univariate analysis revealed that preoperative proteinuria (p = 0.01), operation time (p = 0.04) and estimated blood loss (p = 0.02) were significantly higher in the SSI group compared to the non-SSI group. Multivariate logistic regression identified preoperative proteinuria as a statistically significant predictor of SSI (OR 6.28, 95 % CI 1.58–25.0, p = 0.009).

Conclusions

Proteinuria is a significant predisposing factor for SSI in spinal instrumentation surgery for DM patients. DM patients with proteinuria who are likely to suffer latent nephropathy have a potential risk for SSI. For them less invasive surgery is recommended for spinal instrumentation. In this retrospective study, there was no significant difference of preoperative condition in glycemic control between the two groups.

Keywords

Spinal instrumentation surgery Surgical site infection Diabetes mellitus Proteinuria Microvascular disease Diabetic nephropathy 

Notes

Conflict of interest

None.

References

  1. 1.
    Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeck J (2013) Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19:1711–1719CrossRefGoogle Scholar
  2. 2.
    Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22:605–615PubMedCrossRefGoogle Scholar
  3. 3.
    Lamloum SM, Mobasher LA, Karar AH, Basiony L, Abdallah TH, Al-Saleh AI, Al-Shamali NA (2009) Relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait. Med Princ Pract 18:447–452PubMedCrossRefGoogle Scholar
  4. 4.
    Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, Rogers SO (2008) Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery. Ann Surg 248:585–591PubMedGoogle Scholar
  5. 5.
    Carr JM, Sellke FW, Fey M, Doyle MJ, Krempin JA, de la Torre R, Liddicoat JR (2005) Implementing tight glucose control after coronary artery bypass surgery. Ann Thorac Surg 80:902–909PubMedCrossRefGoogle Scholar
  6. 6.
    Hanazaki K, Maeda H, Okabayashi T (2009) Relationship between perioperative glycemic control and postoperative infections. World J Gastroenterol 15:4122–4125PubMedCrossRefGoogle Scholar
  7. 7.
    Weykamp C, John WG, Mosca A, Hoshino T, Little R, Jeppsson JO, Goodall I, Miedema K, Myers G, Reinauer H, Sacks DB, Slingerland R, Siebelder C (2008) The IFCC reference measurement system for HbA1c: a 6-year progress report. Clin Chem 54:240–248PubMedCrossRefGoogle Scholar
  8. 8.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for the prevention of surgical site infection. Infect Control Hosp Epidemiol 20:247–280CrossRefGoogle Scholar
  9. 9.
    Veeravagu A, Patil CG, Lad SP, Boakye M (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976) 34:1869–1872CrossRefGoogle Scholar
  10. 10.
    McManus LM, Bloodworth RC, Prihoda TJ, Blodgett JL, Pinkard RN (2001) Agonist-dependent failure of neutrophil function in diabetes correlates with extent of hyperglycemia. J Leukoc Biol 70:395–404PubMedGoogle Scholar
  11. 11.
    Bagdade JD, Stewart M, Walters E (1978) Impaired granulocyte adherence. A reversible defect in host defense in patients with poorly controlled diabetes. Diabetes 27:677–681PubMedCrossRefGoogle Scholar
  12. 12.
    Sima AA, O’Neill SJ, Najmark D, Yagihashi S, Klass D (1988) Bacterial phagocytosis and intracellular killing by alveolar macrophages in BB rats. Diabetes 37:544–549PubMedCrossRefGoogle Scholar
  13. 13.
    Mowat A, Baum J (1971) Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N Engl J Med 284:621–627PubMedCrossRefGoogle Scholar
  14. 14.
    Hennessey PJ, Black CT, Andrassy RJ (1991) Nonenzymatic glycosylation of immunoglobulin G impairs complement fixation. JPEN J Parenter Enteral Nutr 15:60–64PubMedCrossRefGoogle Scholar
  15. 15.
    Goodson WH 3rd, Hunt TK (1979) Deficient collagen formation by obese mice in a standard wound model. Am J Surg 138:692–694PubMedCrossRefGoogle Scholar
  16. 16.
    Kamal K, Powell RJ, Sumpio BE (1996) The pathophysiology of diabetes mellitus: implications for surgeons. J Am Coll Surg 183:271–289PubMedGoogle Scholar
  17. 17.
    Selby JV, Karter AJ, Ackerson LM, Ferrara A, Liu J (2001) Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes. Diabetes Care 24:1547–1555PubMedCrossRefGoogle Scholar
  18. 18.
    Jensen S (2000) Microalbuminuria and risk of atherosclerosis. Clinical epidemiological and physiological investigators. Dan Med Bull 47:63–78PubMedGoogle Scholar
  19. 19.
    Hadi HA, Suwaidi JA (2007) Endothelial dysfunction in diabetes mellitus. Vasc Health Risk Manag 3:853–876PubMedGoogle Scholar
  20. 20.
    Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, Dhaliwal R, Henderson WR, Chittock DR, Finfer S, Talmor D (2009) Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 180:821–827PubMedGoogle Scholar
  21. 21.
    Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1283–1297PubMedCrossRefGoogle Scholar
  22. 22.
    McMahon MM, Bistrian BR (1995) Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 9:1–9PubMedGoogle Scholar
  23. 23.
    Jax TW (2010) Metabolic memory: a vascular perspective. Cardiovasc Diabetol 9:51PubMedCrossRefGoogle Scholar
  24. 24.
    Arcaro G, Cretti A, Balzano S, Lechi A, Muggeo M, Bonora E, Bonadonna RC (2002) Insulin causes endothelial dysfunction in humans: sites and mechanisms. Circulation 105:576–582PubMedCrossRefGoogle Scholar
  25. 25.
    Kashiwagi A, Shinozaki K, Nishio Y, Maegawa H, Maeno Y, Kanazawa A, Kojima H, Haneda M, Hidaka H, Yasuda H, Kikkawa R (1999) Endothelium-specific activation of NAD(P)H oxidase in aortas of exogenously hyperinsulinemic rats. Am J Physiol Endocrinol Metab 277:E976–E983Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kotaro Satake
    • 1
    Email author
  • Tokumi Kanemura
    • 1
  • Akiyuki Matsumoto
    • 1
  • Hidetoshi Yamaguchi
    • 1
  • Yoshimoto Ishikawa
    • 2
  1. 1.Department of Orthopaedic SurgeryKonan Kosei HospitalKonanJapan
  2. 2.Department of Orthopaedic SurgeryNagoya UniversityNagoyaJapan

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