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Risk factors for implant removal after spinal surgical site infection

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Abstract

Purpose

Few studies have investigated the risk factors for implant removal after treatment for spinal surgical site infection (SSI). Therefore, there is no firmly established consensus for the management of implants. We aimed to investigate the incidence and risk factors for implant removal after SSI managed with instrumentation, and to examine potential strategies for avoiding implant removal.

Methods

Following a survey of seven spine centers, we retrospectively reviewed the records of 55 patients who developed SSI and were treated with reoperation, out of 3967 patients who had spinal instrumentation between 2003 and 2012. We examined implant survival rate and applied logistic regression analysis to assess the potential risk factors for implant removal.

Results

The overall rate of implant retention was 60% (33/55). A higher implant retention rate was observed for posterior cervical surgery than for posterior-thoracic/lumbar surgery (100 vs. 49%, P < 0.001). On univariate analysis, significant risk factors for implant removal included greater blood loss, delay of reoperation, and delay of intervention with effective antibiotics. Multivariate analysis revealed that a delay in administering effective antibiotics was an independent and significant risk factor for implant removal in posterior-thoracic/lumbar surgery (odds ratio 1.17; 95% confidence interval 1.02–1.35, P = 0.028).

Conclusions

Patients with SSI who underwent posterior cervical surgery are likely to retain the implants. Immediate administration of effective antibiotics improves implant survival in SSI treatment. Our findings can be applied to identify SSI patients at higher risk for implant removal.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihatake-cho, Fukakusa, Fushimi, Kyoto, 612-8555, Japan

    Naoya Tsubouchi

  2. Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Shunsuke Fujibayashi, Bungo Otsuki, Masanori Izeki & Shuichi Matsuda

  3. Department of Orthopedic Surgery, Kobe Central General Hospital Hospital, Kobe, Japan

    Bungo Otsuki

  4. Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan

    Masanori Izeki & Masato Ota

  5. Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan

    Hiroaki Kimura

  6. Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan

    Hiroaki Kimura

  7. Department of Orthopedic Surgery, Osaka Red Cross Hospital, Osaka, Japan

    Takeshi Sakamoto

  8. Department of Orthopedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan

    Akira Uchikoshi

Authors
  1. Naoya Tsubouchi
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  2. Shunsuke Fujibayashi
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  3. Bungo Otsuki
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  4. Masanori Izeki
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  7. Takeshi Sakamoto
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  8. Akira Uchikoshi
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  9. Shuichi Matsuda
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Corresponding author

Correspondence to Naoya Tsubouchi.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This manuscript does not contain information about medical devices/drugs.

Funding

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Tsubouchi, N., Fujibayashi, S., Otsuki, B. et al. Risk factors for implant removal after spinal surgical site infection. Eur Spine J 27, 2481–2490 (2018). https://doi.org/10.1007/s00586-017-5294-1

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  • DOI: https://doi.org/10.1007/s00586-017-5294-1

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