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Incidence, Prevalence, and Analysis of Risk Factors for Surgical Site Infection Following Adult Spinal Surgery

Pull ter Gunne, Albert F. MD; Cohen, David B. MD, MPH

doi: 10.1097/BRS.0b013e3181a03013

Study Design. A retrospective cohort study to identify rates and analyze the risk factors for postoperative spinal wound infection.

Objective. To determine significant risk factors for postoperative spinal wound infection by comparing those patients who developed a postoperative wound infection with the rest of the cohort.

Summary of Background Data. A surgical site infection (SSI) is a common complication after spinal surgery. SSI leads to higher morbidity, mortality, and healthcare costs. To develop strategies to reduce the risk for SSI, independent risk factors for SSI should be identified.

Methods. The electronic patient record of all 3174 patients who underwent orthopedic spinal surgery at out institution were abstracted. Individual patient and perioperative characteristics were stored in an electronic database.

Results. In total, 132 (4.2%) patients were found to have an SSI with 84 having deep based infection. Estimated blood loss over 1 liter (P = 0.017), previous SSI (P = 0.012) and diabetes (P = 0.050) were found to be independent statistically significant risk factors for SSI. Obesity (P = 0.009) was found to significantly increase the risk of superficial infection, whereas anterior spinal approach decreased the risk (P = 0.010). Diabetes (P = 0.033), obesity (P = 0.047), previous SSI (P = 0.009), and longer surgeries (2–5 hours [P = 0.023] and 5 or more hours [P = 0.009]) were found to be independent significant risk factors for deep SSI.

Conclusion. SSI is commonly seen after spinal surgery. In our study, we identified independent risk factors for both deep and superficial SSI. Identification of these risk factors should allow us to design protocols to decrease the risk of SSE in future patients.

Wound infection after spinal surgery is a frequently seen complication. We performed a retrospective study in 3174 patients to identify the rates of superficial and deep surgical site infections following adult spinal surgery and analyzed the various risk factors.

From the Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.

Acknowledgment date: November 5, 2008. Revision date: December 18, 2008. Acceptance date: December 19, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This research is approved by the IRB.

Address correspondence and reprint requests to Albert F. Pull ter Gunne, MD, Department of Orthopaedic Surgery, Johns Hopkins Hospital, 601 N Caroline Street, Baltimore, MD 21287; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.