Surgical site infection risk factors

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Surgical site infection risk factors

Of 16,513 patients in a study, 1.20% required at least one further operation to treat a surgical site infection (SSI). Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative time >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation 1).

It is still discussed if the dual use increases the risk of surgical site infections (SSI).Increase of extent of tumor resection using intraoperative magnetic resonance imaging (iMRI) is evident. SSI rate is within the normal range of neurosurgical procedures. A dual-use iMRI suite is a safe concept 2).

Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust. Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in a study group 3).

Cassir et al. identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30).

For SSIs postspinal surgery, they identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22) 4).

Subcutaneous fat thickness

Nuchal thickness and subcutaneous fat thickness are associated with SSI, in patients undergoing posterior cervical spine surgery. The risk of infection increases with very thin and very thick nuchal measurements 5).

Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery 6).

References

1)

Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K. Risk factors for surgical site infections in neurosurgery. Ann R Coll Surg Engl. 2019 Mar;101(3):220-225. doi: 10.1308/rcsann.2019.0001. Epub 2019 Jan 30. PubMed PMID: 30698457; PubMed Central PMCID: PMC6400918.
2)

Wach J, Goetz C, Shareghi K, Scholz T, Heßelmann V, Mager AK, Gottschalk J, Vatter H, Kremer P. Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results of Resection, Histopathologic Assessment, and Surgical Site Infections. J Neurol Surg A Cent Eur Neurosurg. 2019 Jul 4. doi: 10.1055/s-0039-1692975. [Epub ahead of print] PubMed PMID: 31272122.
3)

Maciejczak A, Wolan-Nieroda A, Wałaszek M, Kołpa M, Wolak Z. Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols. J Hosp Infect. 2019 Apr 30. pii: S0195-6701(19)30186-0. doi: 10.1016/j.jhin.2019.04.017. [Epub ahead of print] PubMed PMID: 31051190.
4)

Cassir N, De La Rosa S, Melot A, Touta A, Troude L, Loundou A, Richet H, Roche PH. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period. Am J Infect Control. 2015 Aug 20. pii: S0196-6553(15)00756-7. doi: 10.1016/j.ajic.2015.07.005. [Epub ahead of print] PubMed PMID: 26300100.
5)

Porche K, Lockney DT, Gooldy T, Kubilis P, Murad G. Nuchal thickness and increased risk of surgical site infection in posterior cervical operations. Clin Neurol Neurosurg. 2021 Apr 25;205:106653. doi: 10.1016/j.clineuro.2021.106653. Epub ahead of print. PMID: 33984797.
6)

Peng W, Liang Y, Lu T, Li M, Li DS, Du KH, Wu JH. Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients: A single-center retrospective analysis. Medicine (Baltimore). 2019 Jun;98(23):e15935. doi: 10.1097/MD.0000000000015935. PubMed PMID: 31169714.

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