Clinical Orthopaedics and Related Research®

, Volume 467, Issue 7, pp 1670–1673 | Cite as

Diabetes Associated with Increased Surgical Site Infections in Spinal Arthrodesis

  • Sam Chen
  • Matt V. Anderson
  • Wayne K. Cheng
  • Montri D. WongworawatEmail author
Symposium: Papers Presented at the 2008 Meeting of the Musculoskeletal Infection Society


Diabetes mellitus (DM) is a major risk factor for surgical site infection (SSI). Spinal surgeries are also associated with an increased risk of SSI. To confirm previous reports we evaluated the association of DM with spine infection in 195 patients who underwent elective posterior instrumented lumbar arthrodesis over a 5-year period: 30 with DM and 165 without. Other known risk factors for SSI in spinal surgery were examined: age, gender, tobacco use, body mass index, American Society of Anesthesiologists (ASA) class, intraoperative antibiotic redosing, surgical time, bone allograft use, estimated blood loss (EBL), and drain use. The adjusted relative risk of having DM for developing SSI was 4.10 (95% C.I. = 1.37–12.32). Other factors did not appear as risk factors for SSI. The data confirm DM is a risk factor for surgical site infections in spinal arthrodesis surgery.

Level of Evidence: Level II, prognostic study (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.


Surgical Site Infection Spinal Surgery Bone Allograft Drain Placement Spinal Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Khaled Bahjri from the Health Research Consulting Group for statistical assistance.


  1. 1.
    Auerbach AD. Chapter 20. Prevention of surgical site infections. Evidence report/technology assessment no. 43. AHRQ publication no. 01-E058. [Agency for Healthcare Research and Quality Web site]. July, 2001. Available at: Accessed July 29, 2008.
  2. 2.
    Beiner JM, Grauer J, Kwon BK, Vaccaro AR. Postoperative wound infections of the spine. Neurosurg Focus. 2003;15;1–5.CrossRefGoogle Scholar
  3. 3.
    Blam OG, Vaccaro AR, Vanichkachorn JS, Albert TJ, Hilibrand AS. Risk factors for surgical site infection in the patient with spinal injury. Spine. 2003;28:1475–1480.PubMedCrossRefGoogle Scholar
  4. 4.
    Bose B. Delayed infection after instrumented spine surgery: case reports and review of the literature. Spine. 2003;3:394–399.CrossRefGoogle Scholar
  5. 5.
    Casses DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med. 1992;326:281–286.CrossRefGoogle Scholar
  6. 6.
    de Boer AS, Mintjes-de Groot AJ, Severijnen AJ, van den Berg JM, van Pelt W. Risk assessment for surgical-site infections in orthopedic patients. Inf Control Hosp Epidemiol. 1999;20:402–407.CrossRefGoogle Scholar
  7. 7.
    Dimick JB, Lipsett PA, Kostuik JP. Spine update: antimicrobial prophylaxis in spine surgery. Spine. 2000;25:2544–2548.PubMedCrossRefGoogle Scholar
  8. 8.
    Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005;30:1460–1465.PubMedCrossRefGoogle Scholar
  9. 9.
    Fletcher, N, Sofianos DM, Berkes MB, Obremskey WT. Current Concepts review: prevention of perioperative infection. J Bone Joint Surg Am. 2007;89:1605–1618.PubMedCrossRefGoogle Scholar
  10. 10.
    Heggeness MH, Esses SI, Errico T, Yuan HA. Late infection of spinal instrumentation by hematogenous seeding. Spine. 1993;18:492–496.PubMedCrossRefGoogle Scholar
  11. 11.
    Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra cost. Infect Control Hosp Epidemiol. 1999;20:725–730.PubMedCrossRefGoogle Scholar
  12. 12.
    Lee, JJ, Singletary R, Schmader K, Anderson D, Bolognesi M. Surgical infection in the elderly following orthopaedic surgery. J Bone Joint Surg Am. 2006;88:1705–1712.PubMedCrossRefGoogle Scholar
  13. 13.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for the prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20:247–280.CrossRefGoogle Scholar
  14. 14.
    National Nosocomial Infections Surveillance System. NNIS System Report, data summary from January 1992 through June 2004. Am J Infect Control. 2004;32:470–485.CrossRefGoogle Scholar
  15. 15.
    Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90:62–69.PubMedCrossRefGoogle Scholar
  16. 16.
    Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2004;86:1146–1152.PubMedCrossRefGoogle Scholar
  17. 17.
    Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, Perra JH. Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord. 2000;13:42–45.PubMedCrossRefGoogle Scholar
  18. 18.
    Polly DW, Meter JJ, Brueckner R, Asplund L, van Dam BE. The effect of intraoperative blood loss on serum cefazolin level in patients undergoing instrumented spinal fusion: a prospective, controlled study. Spine. 1996;21:2363–2367.PubMedCrossRefGoogle Scholar
  19. 19.
    Sasso RC, Garrido, BJ. Postoperative spinal wound infections. J Am Acad Orthop Surg. 2008;16:330–337.PubMedGoogle Scholar
  20. 20.
    Simpson JM, Silveri CP, Balderston RA, Simeone FA, An HS. The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Joint Surg Am. 1993;75:1823–1829.PubMedGoogle Scholar
  21. 21.
    Thu LT, Dibley MJ, Ewald B, Tien NP, Lam LD. Incidence of surgical site infections and accompanying risk factors in Vietnamese orthopaedic patients. J Hosp Infect. 2005;60:360–367.PubMedCrossRefGoogle Scholar
  22. 22.
    Viola RW, King HA, Adler SM, Wilson CB. Delayed infection after elective spinal instrumentation and fusion. Spine. 1997;20:2444–2451.CrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2009

Authors and Affiliations

  • Sam Chen
    • 1
  • Matt V. Anderson
    • 1
  • Wayne K. Cheng
    • 1
  • Montri D. Wongworawat
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryLoma Linda UniversityLoma LindaUSA

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