Acta Neurochirurgica

, Volume 159, Issue 6, pp 1113–1118

Risk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based study

  • Samer Habiba
  • Øystein P. Nygaard
  • Jens I. Brox
  • Christian Hellum
  • Ivar M. Austevoll
  • Tore K. Solberg
Original Article - Spine
  • 189 Downloads

Abstract

Background

There are no previous studies evaluating risk factors for surgical site infections (SSIs) and the effectiveness of prophylactic antibiotic treatment (PAT), specifically for patients operated on for lumbar disc herniation.

Method

This observational multicentre study comprises a cohort of 1,772 consecutive patients operated on for lumbar disc herniation without laminectomy or fusion at 23 different surgical units in Norway. The patients were interviewed about SSIs according to a standardised questionnaire at 3 months’ follow-up.

Results

Three months after surgery, 2.3% of the patients had an SSI. Only no PAT (OR = 5.3, 95% CI = 2.2–12.7, p< 0.001) and longer duration of surgery than the mean time (68 min) (OR = 2.8, 95% CI = 1.2–6.6, p = 0.02) were identified as independent risk factors for SSI. Numbers needed to have PAT to avoid one SSI was 43.

Conclusions

In summary, this study clearly lends support to the use of PAT in surgery for lumbar disc herniation. Senior surgeons assisting inexperienced colleagues to avoid prolonged duration of surgery could also reduce the occurrence of SSI.

Keywords

Degenerative spine Lumbar disc herniation Surgical site infections Antibiotic prophylaxis 

References

  1. 1.
    Barker FG (2002) Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51:391–400CrossRefPubMedGoogle Scholar
  2. 2.
    Bible JE, O’Neill KR, Crosby CG, Schoenecker JG, McGirt MJ, Devin CJ (2012) Microscope sterility during spine surgery. Spine 37:623–627CrossRefPubMedGoogle Scholar
  3. 3.
    Dauch WA (1986) Infection of the intervertebral space following conventional and microsurgical operation on the herniated lumbar intervertebral disc. A controlled clinical trial. Acta Neurochir (Wein) 82:43–49CrossRefGoogle Scholar
  4. 4.
    Dobzyniak MA, Fischgrund JS, Hankins S, Herkowitz HN (2003) Single versus multiple dose antibiotic prophylaxis in lumbar disc surgery. Spine 28:E453–E455CrossRefPubMedGoogle Scholar
  5. 5.
    Dripps RD (1963) New classification of physical status. Anesthesiology 24:111Google Scholar
  6. 6.
    Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine 30:1460–1465CrossRefPubMedGoogle Scholar
  7. 7.
    Friedman ND, Sexton DJ, Connelly SM, Kaye KS (2007) Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol 28:1060–1065CrossRefPubMedGoogle Scholar
  8. 8.
    Højmark K, Støttrup C, Carreon L, Andersen MO (2016) Patient-reported outcome measures unbiased by loss of follow-up. Single-center study based in DaneSpine, the Danish spine surgery registry. Eur Spine J 1:282–286CrossRefGoogle Scholar
  9. 9.
    Jo JE, Miller AO, Cohn MR (2016) Evaluating the diagnostic yield of computer tomography-guided aspiration in suspected post-operative spine infections. HSS J 12:119CrossRefPubMedGoogle Scholar
  10. 10.
    Kanayama M, Hashimoto T, Shigenobu K, Oha F, Togawa D (2007) Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine 6:327–329CrossRefPubMedGoogle Scholar
  11. 11.
    Mastronardi L, Rychlicki F, Tatta C, Morabito L, Agrillo U, Ducati A (2005) Spondylodiscitis after lumbar microdiscectomy: effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases. Neurosurg Rev 28:303–307CrossRefPubMedGoogle Scholar
  12. 12.
    Melloh M, Staub L, Aghayev E, Zweig T, Barz T, Theis JC, Chavanne A, Grob D, Aebi M, Roeder C (2008) The international SPINE registry SPINE TANGO: status quo and first results. Eur Spine J 17:1201–1209CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:149–155PubMedGoogle Scholar
  14. 14.
    Ohrn A, Elfstrom J, Liedgren C, Rutberg H (2011) Reporting of sentinel events in Swedish hospitals: a comparison of severe adverse events reported by patients and providers. Jt Comm J Qual Patient Saf 37:495–501CrossRefPubMedGoogle Scholar
  15. 15.
    O’Toole JE, Eichholz KM, Fessler RG (2009) Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 11:471–476CrossRefPubMedGoogle Scholar
  16. 16.
    Petignat C, Francioli P, Harbarth S, Regli L, Porchet F, Reverdin A, Rilliet B, de Tribolet N, Pannatier A, Pittet D, Zanetti G (2008) Cefuroxime prophylaxis is effective in noninstrumented spine surgery: a double-blind, placebo-controlled study. Spine 33:1919–1924CrossRefPubMedGoogle Scholar
  17. 17.
    Piotrowski WP, Krombholz MA, Muhl B (1994) Spondylodiscitis after lumbar disk surgery. Neurosurg Rev 17:189–193CrossRefPubMedGoogle Scholar
  18. 18.
    Pull ter Gunne AF, Mohamed AS, Skolasky RL, van Laarhoven CJ, Cohen DB (2010) The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery. Spine 35:1323–1328CrossRefPubMedGoogle Scholar
  19. 19.
    Schuster JM, Rechtine G, Norvell DC, Dettori JR (2010) The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine 35:S125–S137CrossRefPubMedGoogle Scholar
  20. 20.
    Shousha M, Cirovic D, Boehm H (2015) Infection rate after minimally invasive noninstrumented spinal surgery based on 4350 procedures. Spine J 40:201–205CrossRefGoogle Scholar
  21. 21.
    Smith JS, Shaffrey CI, Sansur CA, Berven SH, Fu KM, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR Jr, Hart RA, Donaldson WF III, Polly DW Jr, Perra JH, Boachie-Adjei O (2011) Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society morbidity and mortality committee. Spine 36:556–563CrossRefPubMedGoogle Scholar
  22. 22.
    Solberg TK, Sorlie A, Sjaavik K, Nygaard OP, Ingebrigtsen T (2011) Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine? Acta Orthop 82:56–63CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Solberg T, (2013) Ensuring valid and reliable data for quality control and research from a clinical registry for spine surgery. (Doctoral dissertation). Retrieved from http://hdl.handle.net/10037/5733. Accessed 23 March 2017
  24. 24.
    Strömqvist B, Fritzell P, Hagg O, Jonsson B (2009) SWESPINE—The Swedish Spine Register: The 2009 Report. Swedish Society of Spinal Surgeons/Register Group. Available at: http://swespine.se/Arsrapport/English_version_report2009.pdf
  25. 25.
    Veeravagu A, Patil CG, Lad SP, Boakye M (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine 34:1869–1872CrossRefPubMedGoogle Scholar
  26. 26.
    Watanabe M, Sakai D, Matsuyama D, Yamamoto Y, Sato M, Mochida J (2010) Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. J Neurosurg Spine 12:540–546CrossRefPubMedGoogle Scholar
  27. 27.
    Watters WC III, Baisden J, Bono CM, Heggeness MH, Resnick DK, Shaffer WO, Toton JF (2009) Antibiotic prophylaxis in spine surgery: an evidence-based clinical guideline for the use of prophylactic antibiotics in spine surgery. Spine J 9:142–146CrossRefPubMedGoogle Scholar
  28. 28.
    Weiner BK, Kilgore WB (2007) Bacterial shedding in common spine surgical procedures: headlamp/loupes and the operative microscope. Spine 32:918–920CrossRefPubMedGoogle Scholar
  29. 29.
    Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Samer Habiba
    • 1
  • Øystein P. Nygaard
    • 2
    • 3
  • Jens I. Brox
    • 2
    • 4
  • Christian Hellum
    • 2
    • 4
  • Ivar M. Austevoll
    • 2
    • 5
  • Tore K. Solberg
    • 2
    • 6
    • 7
  1. 1.Department of NeurosurgeryHaukeland University HospitalBergenNorway
  2. 2.Norwegian Registry for Spine Surgery (NORspine)Northern Norway Regional Health AuthorityBergenNorway
  3. 3.Department of NeurosurgerySt. Olavs Hospital and Institute of Neuroscience Medical Faculty Norwegian University of Science and Technology (NTNU)TrondheimNorway
  4. 4.Department of OrthopaedicsOslo University Hospital, University of OsloOsloNorway
  5. 5.Department of OrthopaedicsHaukeland University HospitalBergenNorway
  6. 6.Department of NeurosurgeryUniversity Hospital of North NorwayTromsøNorway
  7. 7.The Department of Clinical MedicineUniversity of Tromsø The Arctic University of NorwayTromsøNorway

Personalised recommendations