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 .
Medicaid Status Is Associated With Higher Surgical Site Infection Rates After Spine Surgery
Study Design . The Spine End Results Registry ( 2003–2004 ) is a registry of prospect ively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center . Insurance data were prospect ively collected and used in multivariate analysis to determine risk of perioperative complications . Objective . Given the negative financial impact of surgical site infections ( SSIs ) and the higher overall complication rates of patients with a Medicaid payer status , we hypothesized that a Medicaid payer status would have a significantly higher SSI rate . Summary of Background Data . The medical literature demonstrates lesser outcomes and increased complication rates in patients who have public insurance than those who have private insurance . No one has shown that patients with a Medicaid payer status compared with Medicare and privately insured patients have a significantly increased SSI rate for spine surgery . Methods . The prospect ively collected Spine End Results Registry provided data for analysis . SSI was defined as treatment requiring operative debridement . Demographic , social , medical , and the surgical severity index risk factors were assessed against the exposure of payer status for the surgical procedure . Results . The population included Medicare ( N = 354 ) , Medicaid ( N = 334 ) , the Veterans ' Administration ( N = 39 ) , private insurers ( N = 603 ) , and self-pay ( N = 42 ) . Those patients whose insurer was Medicaid had a 2.06 odds ( 95 % confidence interval : 1.19–3.58 , P = 0.01 ) of having a SSI compared with the privately insured . Conclusion . The study highlights the increased cost of spine surgical procedures for patients with a Medicaid payer status with the passage of the Patient Protection and Affordable Care Act of 2010 . The Patient Protection and Affordable Care Act of 2010 provisions could cause a reduction in reimbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs . This very issue could inadvertently lead to access limitations . 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 .