Abstract
Purpose
The impact of deep surgical site infection (SSI) on surgical outcomes after adult spinal deformity (ASD) surgery is still unclear. We aimed to study the morbidity of SSI in ASD and its impact on deformity correction and functional outcome.
Methods
Prospective multicenter matched-cohort study including consecutively enrolled ASD patients. Patients developing SSI were matched to similar controls in terms of age, gender, ASA, primary or revision, extent of fusion, and use of tri-columnar osteotomies. Preoperative parameters, surgical variables, and complications were recorded. Deformity parameters and Health Related Quality of Life (HRQoL) scores were obtained preoperatively and at 6, 12, and 24 months. Independent t test and Fischer’s exact test were used for comparisons.
Results
444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter.
Conclusion
SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it’s negative impact seems to be diluted by the second postoperative year as differences in HRQoL scores between the two groups decrease.
Graphical abstract
These slides can be retrieved under Electronic Supplementary material.
Similar content being viewed by others
References
Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP, International Spine Study G (2015) A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 3(6):575–594. https://doi.org/10.1016/j.jspd.2015.04.005
Ayhan S, Aykac B, Yuksel S, Guler UO, Pellise F, Alanay A, Perez-Grueso FJ, Acaroglu E, Group EESS (2016) Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year? Eur Spine J 25(8):2471–2479. https://doi.org/10.1007/s00586-015-3981-3
Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I, Mundis G Jr, Shaffrey CI, Kebaish K, Hostin R, Hart R, Gupta MC, Burton D, Ames C, Boachie-Adjei O, Protopsaltis TS, Lafage V, International Spine Study G (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36(5):E18. https://doi.org/10.3171/2014.2.focus1422
McCormick JD, Werner BC, Shimer AL (2013) Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 21(2):99–107. https://doi.org/10.5435/JAAOS-21-02-99
Ames CP, Scheer JK, Lafage V, Smith JS, Bess S, Berven SH, Mundis GM, Sethi RK, Deinlein DA, Coe JD, Hey LA, Daubs MD (2016) Adult spinal deformity: epidemiology, health impact, evaluation, and management. Spine Deform 4(4):310–322. https://doi.org/10.1016/j.jspd.2015.12.009
Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM Jr, Errico TJ, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Soroceanu A, Kelly MP, Line B, Gupta M, Deviren V, Hart R, Burton DC, Bess S, Ames CP, International Spine Study G (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25(1):1–14. https://doi.org/10.3171/2015.11.spine151036
Soroceanu A, Burton DC, Oren JH, Smith JS, Hostin R, Shaffrey CI, Akbarnia BA, Ames CP, Errico TJ, Bess S, Gupta MC, Deviren V, Schwab FJ, Lafage V, International Spine Study G (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine 41(22):1718–1723. https://doi.org/10.1097/brs.0000000000001636
Scheer JK, Mundis GM, Klineberg E, Hart RA, Deviren V, Burton DC, Protopsaltis TS, Gupta M, Rolston JD, Bess S, Shaffrey CI, Schwab F, Lafage V, Smith JS, Ames CP, International Spine Study G (2016) Recovery following adult spinal deformity surgery: the effect of complications and reoperation in 149 patients with 2-year follow-up. Eur Spine J 25(8):2612–2621. https://doi.org/10.1007/s00586-015-3787-3
Mok JM, Guillaume TJ, Talu U, Berven SH, Deviren V, Kroeber M, Bradford DS, Hu SS (2009) Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine 34(6):578–583. https://doi.org/10.1097/BRS.0b013e31819a827c
Falavigna A, Righesso O, Traynelis VC, Teles AR, da Silva PG (2011) Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study: clinical article. J Neurosurg Spine 15(4):399–403. https://doi.org/10.3171/2011.5.SPINE10825
Rihn JA, Lee JY, Ward WT (2008) Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine 33(3):289–294. https://doi.org/10.1097/BRS.0b013e318162016e
Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine 32(24):2764–2770. https://doi.org/10.1097/BRS.0b013e31815a7644
Petilon JM, Glassman SD, Dimar JR, Carreon LY (2012) Clinical outcomes after lumbar fusion complicated by deep wound infection: a case-control study. Spine 37(16):1370–1374. https://doi.org/10.1097/BRS.0b013e31824a4d93
Albert TJ, Purtill J, Mesa J, McIntosh T, Balderston RA (1995) Health outcome assessment before and after adult deformity surgery. A prospective study. Spine 20(18):2002–2004 (discussion p2005)
Weiss LE, Vaccaro AR, Scuderi G, McGuire M, Garfin SR (1997) Pseudarthrosis after postoperative wound infection in the lumbar spine. J Spinal Disord 10(6):482–487
Wang TY, Back AG, Hompe E, Wall K, Gottfried ON (2017) Impact of surgical site infection and surgical debridement on lumbar arthrodesis: a single-institution analysis of incidence and risk factors. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2017.01.020
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132 (quiz 133–134; discussion 196)
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13(10):606–608
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(3):605–615. https://doi.org/10.1007/s00586-012-2514-6
Pull ter Gunne AF, Hosman AJ, Cohen DB, Schuetz M, Habil D, van Laarhoven CJ, van Middendorp JJ (2012) A methodological systematic review on surgical site infections following spinal surgery: part 1: risk factors. Spine 37(24):2017–2033. https://doi.org/10.1097/BRS.0b013e31825bfca8
Yeramaneni S, Robinson C, Hostin R (2016) Impact of spine surgery complications on costs associated with management of adult spinal deformity. Curr Rev Musculoskelet Med 9(3):327–332. https://doi.org/10.1007/s12178-016-9352-9
Casper DS, Zmistowski B, Hollern DA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK (2018) The effect of postoperative spinal infections on patient mortality. Spine 43(3):223–227. https://doi.org/10.1097/BRS.0000000000002277
Mannion AF, Vila-Casademunt A, Domingo-Sabat M, Wunderlin S, Pellise F, Bago J, Acaroglu E, Alanay A, Perez-Grueso FS, Obeid I, Kleinstuck FS, European Spine Study G (2016) The core outcome measures index (COMI) is a responsive instrument for assessing the outcome of treatment for adult spinal deformity. Eur Spine J 25(8):2638–2648. https://doi.org/10.1007/s00586-015-4292-4
Nunez-Pereira S, Pellise F, Rodriguez-Pardo D, Pigrau C, Bago J, Villanueva C, Caceres E (2013) Implant survival after deep infection of an instrumented spinal fusion. Bone Jt J 95-B(8):1121–1126. https://doi.org/10.1302/0301-620x.95b8.30784
Tsubouchi N, Fujibayashi S, Otsuki B, Izeki M, Kimura H, Ota M, Sakamoto T, Uchikoshi A, Matsuda S (2017) Risk factors for implant removal after spinal surgical site infection. Eur Spine J. https://doi.org/10.1007/s00586-017-5294-1
Tominaga H, Setoguchi T, Kawamura H, Kawamura I, Nagano S, Abematsu M, Tanabe F, Ishidou Y, Yamamoto T, Komiya S (2016) Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: a retrospective case-control study. Medicine (Baltimore) 95(43):e5118. https://doi.org/10.1097/MD.0000000000005118
Dipaola CP, Saravanja DD, Boriani L, Zhang H, Boyd MC, Kwon BK, Paquette SJ, Dvorak MF, Fisher CG, Street JT (2012) Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection. Spine J 12(3):218–230. https://doi.org/10.1016/j.spinee.2012.02.004
Cahill PJ, Warnick DE, Lee MJ, Gaughan J, Vogel LE, Hammerberg KW, Sturm PF (2010) Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 35(12):1211–1217. https://doi.org/10.1097/BRS.0b013e3181c212d1
Acknowledgements
The ESSG receives research funds from DePuy-Synthes.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has any potential conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Haddad, S., Núñez-Pereira, S., Pigrau, C. et al. The impact of deep surgical site infection on surgical outcomes after posterior adult spinal deformity surgery: a matched control study. Eur Spine J 27, 2518–2528 (2018). https://doi.org/10.1007/s00586-018-5583-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5583-3