Surgical associated factors — preoperative radiation/postoperative blood transfusion , combined anterior/posterior approach , surgical invasiveness , or levels of instrumentation were associated with increased SSI .
There is mixed evidence of age , duration of surgery , surgical team , intraoperative blood loss , dural tear , and urinary tract infection/urinary catheter in association with SSI .
Conclusion : SSIs are associated with many risk factors that can be patient or surgically related .
Objective : To perform a review of SSI risk factors and more specifically , categorize them into patient and surgical factors .
Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion
Study Design . A retrospective review of data collected prospect ively by the American College of Surgeons National Surgical Quality Improvement Program ( ACS-NSQIP ) . Objective . The aim of this study was to investigate the association between preoperative hypoalbuminemia , a marker for malnutrition , and complications during the 30 days following posterior lumbar fusion surgery . Summary of Background Data . Malnutrition is a potentially modifiable risk factor that may contribute to complications following spinal surgery . Although prior studies have identified associations between malnutrition , delayed wound healing , and surgical site infection ( SSI ) , the evidence for such a relationship within spine surgery is mixed . Methods . Patients who underwent posterior lumbar spinal fusion of one to three levels as part of the ACS-NSQIP were identified . Patients without preoperative serum albumin concentration were excluded . Outcomes were compared between patients with and without hypoalbuminemia ( defined as serum albumin concentration < 3.5 g/dL ) . All comparisons were adjusted for baseline differences between population s. Results . Four thous and three hundred ten patients were included . The prevalence of hypoalbuminemia was 4.8 % . In comparison to patients with normal albumin concentration , patients with hypoalbuminemia had a higher risk for occurrence of wound dehiscence [ 1.5 % vs. 0.2 % , adjusted relative risk ( RR ) = 5.8 , P = 0.006 ] , SSI ( 5.4 % vs. 1.7 % , adjusted RR = 2.3 , P = 0.010 ) , and urinary tract infection ( 5.4 % vs. 1.5 % , adjusted RR = 2.5 , P = 0.005 ) . Similarly , patients with hypoalbuminemia had a higher risk for unplanned hospital readmission within 30 days of surgery ( 11.7 % vs. 5.4 % , RR = 1.8 , P < 0.001 ) . Finally , patients with hypoalbuminemia had a longer mean inpatient stay ( 5.2 vs. 3.7 days , RR = 1.2 , P < 0.001 ) . Conclusion . The present study suggests that malnutrition is an independent risk factor for infectious and wound complications following posterior lumbar fusion . Malnutrition was also associated with an increased length of stay and readmission . Future studies should evaluate methods of correcting malnutrition before lumbar spinal surgery . Such efforts have the potential to meaningfully decrease the rates of adverse events following this procedure . Level of Evidence :
Surgical associated factors — preoperative radiation/postoperative blood transfusion , combined anterior/posterior approach , surgical invasiveness , or levels of instrumentation were associated with increased SSI .
There is mixed evidence of age , duration of surgery , surgical team , intraoperative blood loss , dural tear , and urinary tract infection/urinary catheter in association with SSI .
Conclusion : SSIs are associated with many risk factors that can be patient or surgically related .
Objective : To perform a review of SSI risk factors and more specifically , categorize them into patient and surgical factors .