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 .
Risk factors for surgical site infection after posterior cervical spine surgery: an analysis of 5,441 patients from the ACS NSQIP 2005-2012.
BACKGROUND CONTEXT The incidence of surgical site infection ( SSI ) following posterior cervical surgery has been reported as high as 18 % in the literature . Few large studies have specifically examined posterior cervical procedures . PURPOSE The study aims to examine the incidence , timing , and risk factors for SSI following posterior cervical surgery . DESIGN This is a retrospective cohort study of prospect ively collected data in a national surgical outcomes data base . PATIENT SAMPLE The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project ( ACS NSQIP ) Participant Use Data File . OUTCOME MEASURES The 30-day rate of postoperative SSI , timing of diagnosis , and associated risk factors were determined . METHODS The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012 . Thirty-day readmission data were obtained for 2011 - 2012 . The incidence and timing of SSI were determined . Multivariable logistic regression analysis was then performed to identify significant risk factors . RESULTS Of the 5,441 patients identified as having undergone posterior cervical surgery , 3,724 had a posterior cervical decompression , 1,310 had a posterior cervical fusion , and 407 underwent cervical laminoplasty .  Surgical site infection within 30 days was identified in 160 patients ( 2.94 % ) , with 80 of those cases being superficial SSI . There was no significant difference in SSI rate among the three procedure groups . The average time for diagnosis of SSI was over 2 weeks . In 2011 - 2012 , 36.9 % of patients with SSI were readmitted within 30 days . Several significant predictors of SSI were identified in univariate analysis , including body mass index ( BMI ) > 35 , chronic steroid use , albumin <3 , hematocrit <33 , platelets < 100 , higher American Society of Anesthesiologists class , longer operative time , and longer hospital admission . Independent risk factors , including BMI > 35 ( odds ratio [OR]=1.78 , p=.003 ) , chronic steroid use ( OR=1.73 , p=.049 ) , and operative time > 197 minutes ( OR=2.08 , p=.005 ) , were identified in multivariable analysis . CONCLUSIONS Optimization of preoperative nutritional status , serum blood cell counts , and operative efficiency may lead to a reduction in SSI rates . Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk
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 .