Surgical site infection after osteotomy of the adult spine: does type of osteotomy matter?
Received 6 August 2009; received in revised form 2 October 2009; accepted 15 November 2009. published online 18 January 2010.
Abstract
Background context
Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other spinal surgeries. Both of these factors have previously been identified as significant risk factors for SSI. We performed a cohort study of this high-risk population to identify risk factors and rates of SSI after spinal osteotomy surgery and identify difference in risk between different types of osteotomies.
Purpose
The objective of the study was to assess the incidence and identify significant risk factors for surgical site infection (SSI) after spinal osteotomy.
Study design
Retrospective review of all adult patients who underwent spinal osteotomy surgery for deformity by an orthopedic surgeon in our university.
Methods
All electronic records of adult orthopedic patients whom underwent a spinal osteotomy procedure at our department between January 1998 and December 2005 (n=363) were abstracted. During surgery, a pedicle subtraction osteotomy (transpedicular wedge resection), anterior spine osteotomy (resection of anterior and middle columns), posterior Smith-Petersen osteotomy (resection of a portion of the superior and inferior lamina, ligamentum flavum, and the inferior and superior articular processed), or a combined anterior and posterior osteotomy (vertebral column resection [VCR]) (circumferential resection of the vertebrae via either a combined anterior/posterior or posterior-only approach) was performed. Primary outcome measurement was SSI. Subanalysis to deep and superficial SSI was performed.
Results
Twenty patients (5.5%) were found to have an SSI, with nine (2.5%) having deep SSI. Analysis showed that patients undergoing VCR (p=.042) had a significant increased risk for deep SSI (11.1%). Obese patients had a significant increased risk (p=.045) for superficial SSI.
Conclusions
Vertebral column resection has a significant increased risk for SSI (11.1%) compared with other types of osteotomies (4.1%). When possible, osteotomy techniques that involve less extensive exposures and soft-tissue dissection should be chosen to minimize deep SSI risk. Obese patients should be counseled on weight loss to try minimizing superficial SSI risk.
aDepartment of Orthopaedic Surgery, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287, USA
bDepartment of General Surgery, Universitair Medisch Centrum St Radboud, Afdeling Heelkunde Huispost 690, Route 690, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
Corresponding author. Department of Orthopaedic Surgery, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287, USA. Tel.: (410) 955-0981; fax: (410) 614-1451.
FDA device/drug status: not applicable.
Authors disclosures: AFPG (grants, Prof. Michael van Vloten foundation; fellowship support, Synthes); DBC (fellowship support, DePuy Spine).
This research was approved by the institutional review board.
ABSTRACT