Skip to main content

Advertisement

SpringerLink
Log in

The impact of deep surgical site infection on surgical outcomes after posterior adult spinal deformity surgery: a matched control study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The impact of deep surgical site infection (SSI) on surgical outcomes after adult spinal deformity (ASD) surgery is still unclear. We aimed to study the morbidity of SSI in ASD and its impact on deformity correction and functional outcome.

Methods

Prospective multicenter matched-cohort study including consecutively enrolled ASD patients. Patients developing SSI were matched to similar controls in terms of age, gender, ASA, primary or revision, extent of fusion, and use of tri-columnar osteotomies. Preoperative parameters, surgical variables, and complications were recorded. Deformity parameters and Health Related Quality of Life (HRQoL) scores were obtained preoperatively and at 6, 12, and 24 months. Independent t test and Fischer’s exact test were used for comparisons.

Results

444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter.

Conclusion

SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it’s negative impact seems to be diluted by the second postoperative year as differences in HRQoL scores between the two groups decrease.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP, International Spine Study G (2015) A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 3(6):575–594. https://doi.org/10.1016/j.jspd.2015.04.005

    Article  PubMed  Google Scholar 

  2. Ayhan S, Aykac B, Yuksel S, Guler UO, Pellise F, Alanay A, Perez-Grueso FJ, Acaroglu E, Group EESS (2016) Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year? Eur Spine J 25(8):2471–2479. https://doi.org/10.1007/s00586-015-3981-3

    Article  PubMed  Google Scholar 

  3. Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I, Mundis G Jr, Shaffrey CI, Kebaish K, Hostin R, Hart R, Gupta MC, Burton D, Ames C, Boachie-Adjei O, Protopsaltis TS, Lafage V, International Spine Study G (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36(5):E18. https://doi.org/10.3171/2014.2.focus1422

    Article  PubMed  Google Scholar 

  4. McCormick JD, Werner BC, Shimer AL (2013) Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 21(2):99–107. https://doi.org/10.5435/JAAOS-21-02-99

    Article  PubMed  Google Scholar 

  5. Ames CP, Scheer JK, Lafage V, Smith JS, Bess S, Berven SH, Mundis GM, Sethi RK, Deinlein DA, Coe JD, Hey LA, Daubs MD (2016) Adult spinal deformity: epidemiology, health impact, evaluation, and management. Spine Deform 4(4):310–322. https://doi.org/10.1016/j.jspd.2015.12.009

    Article  PubMed  Google Scholar 

  6. Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM Jr, Errico TJ, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Soroceanu A, Kelly MP, Line B, Gupta M, Deviren V, Hart R, Burton DC, Bess S, Ames CP, International Spine Study G (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25(1):1–14. https://doi.org/10.3171/2015.11.spine151036

    Article  PubMed  Google Scholar 

  7. Soroceanu A, Burton DC, Oren JH, Smith JS, Hostin R, Shaffrey CI, Akbarnia BA, Ames CP, Errico TJ, Bess S, Gupta MC, Deviren V, Schwab FJ, Lafage V, International Spine Study G (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine 41(22):1718–1723. https://doi.org/10.1097/brs.0000000000001636

    Article  PubMed  Google Scholar 

  8. Scheer JK, Mundis GM, Klineberg E, Hart RA, Deviren V, Burton DC, Protopsaltis TS, Gupta M, Rolston JD, Bess S, Shaffrey CI, Schwab F, Lafage V, Smith JS, Ames CP, International Spine Study G (2016) Recovery following adult spinal deformity surgery: the effect of complications and reoperation in 149 patients with 2-year follow-up. Eur Spine J 25(8):2612–2621. https://doi.org/10.1007/s00586-015-3787-3

    Article  PubMed  Google Scholar 

  9. Mok JM, Guillaume TJ, Talu U, Berven SH, Deviren V, Kroeber M, Bradford DS, Hu SS (2009) Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine 34(6):578–583. https://doi.org/10.1097/BRS.0b013e31819a827c

    Article  PubMed  Google Scholar 

  10. Falavigna A, Righesso O, Traynelis VC, Teles AR, da Silva PG (2011) Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study: clinical article. J Neurosurg Spine 15(4):399–403. https://doi.org/10.3171/2011.5.SPINE10825

    Article  PubMed  Google Scholar 

  11. Rihn JA, Lee JY, Ward WT (2008) Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine 33(3):289–294. https://doi.org/10.1097/BRS.0b013e318162016e

    Article  PubMed  Google Scholar 

  12. Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine 32(24):2764–2770. https://doi.org/10.1097/BRS.0b013e31815a7644

    Article  PubMed  Google Scholar 

  13. Petilon JM, Glassman SD, Dimar JR, Carreon LY (2012) Clinical outcomes after lumbar fusion complicated by deep wound infection: a case-control study. Spine 37(16):1370–1374. https://doi.org/10.1097/BRS.0b013e31824a4d93

    Article  PubMed  Google Scholar 

  14. Albert TJ, Purtill J, Mesa J, McIntosh T, Balderston RA (1995) Health outcome assessment before and after adult deformity surgery. A prospective study. Spine 20(18):2002–2004 (discussion p2005)

    Article  CAS  PubMed  Google Scholar 

  15. Weiss LE, Vaccaro AR, Scuderi G, McGuire M, Garfin SR (1997) Pseudarthrosis after postoperative wound infection in the lumbar spine. J Spinal Disord 10(6):482–487

    Article  CAS  PubMed  Google Scholar 

  16. Wang TY, Back AG, Hompe E, Wall K, Gottfried ON (2017) Impact of surgical site infection and surgical debridement on lumbar arthrodesis: a single-institution analysis of incidence and risk factors. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2017.01.020

    Article  PubMed  Google Scholar 

  17. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132 (quiz 133–134; discussion 196)

    Article  CAS  PubMed  Google Scholar 

  18. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13(10):606–608

    Article  CAS  PubMed  Google Scholar 

  19. Xing D, Ma JX, Ma XL, Song DH, Wang J, Chen Y, Yang Y, Zhu SW, Ma BY, Feng R (2013) A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22(3):605–615. https://doi.org/10.1007/s00586-012-2514-6

    Article  PubMed  Google Scholar 

  20. Pull ter Gunne AF, Hosman AJ, Cohen DB, Schuetz M, Habil D, van Laarhoven CJ, van Middendorp JJ (2012) A methodological systematic review on surgical site infections following spinal surgery: part 1: risk factors. Spine 37(24):2017–2033. https://doi.org/10.1097/BRS.0b013e31825bfca8

    Article  PubMed  Google Scholar 

  21. Yeramaneni S, Robinson C, Hostin R (2016) Impact of spine surgery complications on costs associated with management of adult spinal deformity. Curr Rev Musculoskelet Med 9(3):327–332. https://doi.org/10.1007/s12178-016-9352-9

    Article  PubMed  PubMed Central  Google Scholar 

  22. Casper DS, Zmistowski B, Hollern DA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK (2018) The effect of postoperative spinal infections on patient mortality. Spine 43(3):223–227. https://doi.org/10.1097/BRS.0000000000002277

    Article  PubMed  Google Scholar 

  23. Mannion AF, Vila-Casademunt A, Domingo-Sabat M, Wunderlin S, Pellise F, Bago J, Acaroglu E, Alanay A, Perez-Grueso FS, Obeid I, Kleinstuck FS, European Spine Study G (2016) The core outcome measures index (COMI) is a responsive instrument for assessing the outcome of treatment for adult spinal deformity. Eur Spine J 25(8):2638–2648. https://doi.org/10.1007/s00586-015-4292-4

    Article  CAS  PubMed  Google Scholar 

  24. Nunez-Pereira S, Pellise F, Rodriguez-Pardo D, Pigrau C, Bago J, Villanueva C, Caceres E (2013) Implant survival after deep infection of an instrumented spinal fusion. Bone Jt J 95-B(8):1121–1126. https://doi.org/10.1302/0301-620x.95b8.30784

    Article  CAS  Google Scholar 

  25. Tsubouchi N, Fujibayashi S, Otsuki B, Izeki M, Kimura H, Ota M, Sakamoto T, Uchikoshi A, Matsuda S (2017) Risk factors for implant removal after spinal surgical site infection. Eur Spine J. https://doi.org/10.1007/s00586-017-5294-1

    Article  PubMed  Google Scholar 

  26. Tominaga H, Setoguchi T, Kawamura H, Kawamura I, Nagano S, Abematsu M, Tanabe F, Ishidou Y, Yamamoto T, Komiya S (2016) Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: a retrospective case-control study. Medicine (Baltimore) 95(43):e5118. https://doi.org/10.1097/MD.0000000000005118

    Article  Google Scholar 

  27. Dipaola CP, Saravanja DD, Boriani L, Zhang H, Boyd MC, Kwon BK, Paquette SJ, Dvorak MF, Fisher CG, Street JT (2012) Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection. Spine J 12(3):218–230. https://doi.org/10.1016/j.spinee.2012.02.004

    Article  PubMed  Google Scholar 

  28. Cahill PJ, Warnick DE, Lee MJ, Gaughan J, Vogel LE, Hammerberg KW, Sturm PF (2010) Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 35(12):1211–1217. https://doi.org/10.1097/BRS.0b013e3181c212d1

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The ESSG receives research funds from DePuy-Synthes.

Author information

Authors and Affiliations

  1. Hospital Universitari de la Vall d’Hebron, Barcelona, Spain

    Sleiman Haddad, Carlos Pigrau, Dolors Rodríguez-Pardo & Ferran Pellisé

  2. Universitat Autonoma de Barcelona, Barcelona, Spain

    Sleiman Haddad

  3. Hospital Universitario Donostia, Donostia, Spain

    Susana Núñez-Pereira

  4. Vall dHebron Institute of Research (VHIR), Barcelona, Spain

    Alba Vila-Casademunt

  5. Acibadem University School of Medicine, Istanbul, Turkey

    Ahmet Alanay

  6. Ankara ARTES Spine Center, Kavaklidere, Turkey

    Emre R. Acaroglu

  7. Department of Spine Surgery, Schulthess Clinic, Zuerich, Switzerland

    Frank S. Kleinstueck

  8. CHU Bordeaux Pellegrin Hospital, Bordeaux, France

    Ibrahim Obeid

  9. Hospital de La Paz, Madrid, Spain

    Francisco Javier Sanchez Perez-Grueso

Authors
  1. Sleiman Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susana Núñez-Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Pigrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dolors Rodríguez-Pardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alba Vila-Casademunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmet Alanay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emre R. Acaroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Frank S. Kleinstueck
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ibrahim Obeid
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francisco Javier Sanchez Perez-Grueso
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ferran Pellisé
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

European Spine Study Group

Corresponding author

Correspondence to Sleiman Haddad.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 602 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haddad, S., Núñez-Pereira, S., Pigrau, C. et al. The impact of deep surgical site infection on surgical outcomes after posterior adult spinal deformity surgery: a matched control study. Eur Spine J 27, 2518–2528 (2018). https://doi.org/10.1007/s00586-018-5583-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5583-3

Keywords

Search

Navigation