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Medicosurgical management of deep wound infections after thoracolumbar instrumentation: risk factors of poor outcomes

  • Original Article -Spine - Other
  • Published:
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Abstract

Background

Surgical site infection (SSI) after thoracolumbar osteosynthesis is a common complication. Its management relies on surgical revision and antibiotic therapy, but treatment failure is not uncommon. The aim of our study was to assess the frequency of SSI management failure and its risk factors.

Methods

A retrospective study of patients hospitalized from 2011 to 2019 at the University Hospital of Caen was carried out. The infection rate and the time to onset of failure were assessed over a minimum follow-up of 1 year. Treatment failure was defined as the occurrence of a new intervention in the spine in the year following the end of antibiotic therapy, the establishment of long-term suppressive antibiotic therapy, or death from any cause within 1 year of the end of antibiotic therapy. We compared the treatment failure group with the treatment success group to determine risk factors for treatment failure.

Results

A total of 2881 patients underwent surgery during the study period, and 92 developed an SSI, corresponding to an SSI rate of 3.19%. Thirty-six percent of the patients with an SSI presented treatment failure. The median time to failure was 31 days. On multivariate analysis, diabetes mellitus was identified as a risk factor for treatment failure, whereas prolonged postoperative drainage for 4 to 5 days was a protective factor.

Conclusions

The number of failures was significant, and failure occurred mainly during the early phase. To decrease the risk of treatment failure, prolonged duration of postoperative drainage seems to be helpful. Additionally, as diabetes is a risk factor for treatment failure, good control of glycemia in these patients might impact their outcomes.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

MDR:

Multiresistant bacteria

DAIR:

Debridement, antibiotic, irrigation, and implant retention

IS/RS interval:

Initial surgery/revision surgery interval

MetiR:

Methicillin resistant

SSI:

Surgical site infection

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France

    Paul Frechon, Evelyne Emery & Thomas Gaberel

  2. Department of Infectious Diseases, Caen University Hospital, Avenue de La Côte de Nacre, CHU Caen, 14033, Caen, France

    Jocelyn Michon, Aurelie Baldolli, Renaud Verdon & Anna Fournier

  3. Physiopathology and Imaging of Neurological Disorders (PhIND), Normandie Université, UNICAEN, INSERM, UMR-S U1237, GIP Cyceron, 14000, Caen, France

    Evelyne Emery & Thomas Gaberel

  4. Department of Neurosurgery, Saint Martin Private Hospital, 18 rue des Roquemonts, 14000, Caen, France

    François Lucas

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  1. Paul Frechon
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Contributions

PF and TG designed the study. PF, JM, AB, and FL made the data recording. PF and AF made the statistical analysis. PF and TG wrote the manuscript. TG, EE, RV, JM, AB, and AF corrected the manuscript.

Corresponding author

Correspondence to Paul Frechon.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee of the Caen Normandie University Hospital (n 1099) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Spine - Other

Appendix

Appendix

Deep incisional SSI

Must meet the following criteria

The date of event occurs within 30 or 90 days after the NHSN operative procedure (where day 1 = the procedure date) according to the list in Table 2

AND

involves deep soft tissues of the incision (for example, fascial and muscle layers)

AND

patient has at least one of the following:

  a. purulent drainage from the deep incision

  b. a deep incision that spontaneously dehisces, or is deliberately opened or aspirated by a surgeon, physician*·or physician designee

      AND

      organism(s) identified from the deep soft tissues of the incision by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST)) or culture or non­culture based microbiologic testing method is not performed. A culture or non-culture based test from the deep soft tissues of the incision that has a negative finding does not meet this criterion

     AND

     patient has at least one of the following signs or symptoms: fever (> 38 °C); localized pain or tenderness

  c. an abscess or other evidence of infection involving the deep incision that is detected on gross anatomical or histopathologic exam, or imaging test

*The term physician for the purpose of application of the NHSN SSI criteria may be interpreted to mean a surgeon, infectious disease physician, emergency physician, other physician on the case, or physi cian’s designee (nurse practitioner or physician’s assistant)

  1. Definition of a deep SSI-Center for Disease Control-2021

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Frechon, P., Michon, J., Baldolli, A. et al. Medicosurgical management of deep wound infections after thoracolumbar instrumentation: risk factors of poor outcomes. Acta Neurochir 164, 881–890 (2022). https://doi.org/10.1007/s00701-022-05128-7

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