Diagnostic performance of suction drainage fluid culture for acute surgical site infection after aseptic instrumented spine surgery: a retrospective analysis of 363 cases

Abstract

Purpose

Analyze the diagnostic performance of suction drainage fluid culture for acute surgical site infection, which has not been specifically reported in spine surgery patients.

Method

This was a retrospective single-center observational study including data from 363 patients who underwent aseptic instrumented spine surgery between 2015 and 2017. A suction drain was inserted in all cases. Data analyzed were patient age, gender, ASA score, indication for surgery (degenerative disease, tumor, trauma), spine level (cervical, thoracic, lumbar), procedure performed and spine level, operative time, body temperature, postoperative C-reactive protein time-curve, clinical aspect of surgical scar, bacteriology results of suction drainage fluid, and in case of revision surgery, lavage fluid. Major criteria for periprosthetic infection proposed by the Musculoskeletal Infection Society (MSIS) were accepted as the gold standard for the diagnosis of acute surgical site infection.

Results

The overall rate of surgical site infection was 6.9% (5.76% for 1- or 2-level fusion, 5.81% for 3- or 4-level fusion, and 15.6% for 5-level fusion and above). The suction drain was withdrawn on the second postoperative day in 44.1% of cases and the third day in 39.1%. The sensitivity of suction drainage fluid culture for the diagnosis of surgical site infection was 20% [95%CI 6.8–40.7%] with a 96.2% [95%CI 93.2–97.9] specificity.

Conclusion

The diagnostic performance of suction drainage fluid culture after aseptic instrumented spine surgery for acute surgical site infection is insufficient to warrant its use in routine practice.

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Code availability

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Acknowledgements

We thank Dr. Pope Gerald for his help in the translation of this article.

Funding

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Authors

Contributions

NR performed the data extraction and was a major contributor in writing the manuscript, FD and PW controlled the microbiological results and helped analyzing them, DC and JFD carefully read and corrected the manuscript, SG performed the biostatistical analyzes, AP designed the study and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nathan Ringeval.

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Conflict of interest

All authors certify that they have no conflict of interests.

Data availability and materials

All data are available at the biostatistics laboratory of the Clinical Research Delegation of our institution.

Consent to participate

All patients were informed and had the possibility to refuse to participate.

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Not applicable.

Ethics approval

This study received the approbation from our local ethics committee (CIER: Comité Interne d’Ethique de la Recherche du GHICL), reference number 2018-03-21-A, which ruled that no formal ethics approval was required in this particular case.

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Ringeval, N., Decrucq, F., Weyrich, P. et al. Diagnostic performance of suction drainage fluid culture for acute surgical site infection after aseptic instrumented spine surgery: a retrospective analysis of 363 cases. Eur J Orthop Surg Traumatol (2020). https://doi.org/10.1007/s00590-020-02755-7

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Keywords

  • Spine surgery
  • Spine fusion
  • Surgical site infection
  • Suction drainage
  • Bacteriology culture