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Rates of Infection After Spine Surgery Based on 108,419 Procedures: A Report from the Scoliosis Research Society Morbidity and Mortality Committee

Smith, Justin S. MD, PhD*; Shaffrey, Christopher I. MD*; Sansur, Charles A. MD; Berven, Sigurd H. MD; Fu, Kai-Ming G. MD, PhD*; Broadstone, Paul A. MD§; Choma, Theodore J. MD; Goytan, Michael J. MD||; Noordeen, Hilali H. MD**; Knapp, Dennis R. Jr. MD††; Hart, Robert A. MD‡‡; Donaldson, William F. III MD§§; Polly, David W. Jr MD|| ||; Perra, Joseph H. MD***; Boachie-Adjei, Oheneba MD†††

doi: 10.1097/BRS.0b013e3181eadd41
Deformity

Study Design. Retrospective review of a prospectively collected database.

Objective. Our objective was to assess the rates of postoperative wound infection associated with spine surgery.

Summary of Background Data. Although wound infection after spine surgery remains a common source of morbidity, estimates of its rates of occurrence remain relatively limited. The Scoliosis Research Society prospectively collects morbidity and mortality data from its members, including the occurrence of wound infection.

Methods. The Scoliosis Research Society morbidity and mortality database was queried for all reported spine surgery cases from 2004 to 2007. Cases were stratified based on factors including diagnosis, adult (≥21 years) versus pediatric (<21 years), primary versus revision, use of implants, and whether a minimally invasive approach was used. Superficial, deep, and total infection rates were calculated.

Results. In total, 108,419 cases were identified, with an overall total infection rate of 2.1% (superficial = 0.8%, deep = 1.3%). Based on primary diagnosis, total postoperative wound infection rate for adults ranged from 1.4% for degenerative disease to 4.2% for kyphosis. Postoperative wound infection rates for pediatric patients ranged from 0.9% for degenerative disease to 5.4% for kyphosis. Rate of infection was further stratified based on subtype of degenerative disease, type of scoliosis, and type of kyphosis for both adult and pediatric patients. Factors associated with increased rate of infection included revision surgery (P < 0.001), performance of spinal fusion (P < 0.001), and use of implants (P < 0.001). Compared with a traditional open approach, use of a minimally invasive approach was associated with a lower rate of infection for lumbar discectomy (0.4% vs. 1.1%; P < 0.001) and for transforaminal lumbar interbody fusion (1.3% vs. 2.9%; P = 0.005).

Conclusion. Our data suggest that postsurgical infection, even among skilled spine surgeons, is an inherent potential complication. These data provide general benchmarks of infection rates as a basis for ongoing efforts to improve safety of care.

Rates of postoperative wound infection are presented based on 108,419 spine surgery cases from the Scoliosis Research Society Morbidity and Mortality database. Rates of infection have been assessed based on diagnosis, as well as surgical factors including use of implants and use of minimally invasive approaches.

*Departments of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD

Department of Orthopedic Surgery, University of California—San Francisco, San Francisco, CA

§Spine Surgery Associates, Chattanooga, TN

Orthopedic Surgery, University of Missouri, Columbia, MO

||Health Sciences Centre, Winnipeg, Canada

**The Royal National Orthopedic Hospital and the Great Ormond Street Children's Hospital, London, UK

††Arnold Palmer Children's Center, Orlando, FL

‡‡Department of Orthopedic Surgery, Oregon Health and Science University, Portland

§§Departments of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA

|| ||Departments of Orthopedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN

***Twin Cities Spine Center, Minneapolis, MN

†††Hospital for Special Surgery, New York, NY.

Address correspondence and reprint requests to Christopher I. Shaffrey, MD, Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908; E-mail: CIS8Z@hscmail.mcc.virginia.edu.

Acknowledgment date: September 17, 2009. Revision date: December 10, 2009. Acceptance date: January 7, 2010.

No external funding was received for this project.

This project was submitted to the Hospital for Special Surgery (New York, NY) institutional review board and was determined to be exempt from institutional review board approval based on the use of deidentified data (institutional review board number 29045).

© 2011 Lippincott Williams & Wilkins, Inc.