Abstract
BACKGROUND CONTEXT
Surgical site infections (SSI) are one the most frequent and costly complications
following spinal surgery. The SSI rates of different surgical approaches need to be
analyzed to successfully minimize SSI occurrence.
PURPOSE
The purpose of this study was to define the rate of SSIs in patients undergoing full-endoscopic
spine surgery (FESS) and then to compare this rate against a propensity score-matched
cohort from the National Surgical Quality Improvement Program (NSQIP) database.
DESIGN
This is a retrospective multicenter cohort study using a propensity score-matched
analysis of prospectively maintained databases.
PATIENT SAMPLE
A total of 1277 noninstrumented FESS cases between 2015 and 2021 were selected for
analysis. In the nonendoscopic NSQIP cohort we selected data of 55,882 patients.
OUTCOME MEASURES
The occurrence of any SSI was the primary outcome. We also collected any other perioperative
complications, demographic data, comorbidities, operative details, history of smoking,
and chronic steroid intake.
METHODS
All FESS cases from a multi-institutional group that underwent surgery from 2015 to
2021 were identified for analysis. A cohort of cases for comparison was identified
from the NSQIP database using Current Procedural Terminology of nonendoscopic cervical,
thoracic, and lumbar procedures from 2015 to 2019. Trauma cases as well as arthrodesis
procedures, surgeries to treat pathologies affecting more than 4 levels or spine tumors
that required surgical treatment were excluded. In addition, nonelective cases, and
patients with wounds worse than class 1 were also not included. Patient demographics,
comorbidities, and operative details were analyzed for propensity matching.
RESULTS
In the nonpropensity-matched dataset, the endoscopic cohort had a significantly higher
incidence of medical comorbidities. The SSI rates for nonendoscopic and endoscopic
patients were 1.2% and 0.001%, respectively, in the nonpropensity match cohort (p-value
<.011). Propensity score matching yielded 5936 nonendoscopic patients with excellent
matching (standard mean difference of 0.007). The SSI rate in the matched population
was 1.1%, compared to 0.001% in endoscopic patients with an odds ratio 0.063 (95%
confidence interval (CI) 0.009–0.461, p=.006) favoring FESS.
CONCLUSIONS
FESS compares favorably for risk reduction in SSI following spinal decompression surgeries
with similar operative characteristics. As a consequence, FESS may be considered the
optimal strategy for minimizing SSI morbidity.
Keywords
Abbreviations:
FESS (full-endoscopic spine surgery), SSI (surgical site infection), MISS (minimally invasive spinal surgery)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 25, 2023
Accepted:
January 18,
2023
Received in revised form:
December 15,
2022
Received:
June 9,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: MAM: Stock Ownership: Renerva (# of shares unknown), Consulting: SPR Therapeutics (# of shares unknown), Consulting: Renerva (# of shares unknown), Consulting: Joimax (# of shares unknown), Research Support (Investigator Salary, Staff/Materials): NIH; DoD, AANS/CNS, Boston Scientific Axogen, University of Utah. TP: Nothing to disclose. RBK: Nothing to disclose. SS: Nothing to disclose. KAK: Nothing to disclose ONK: Nothing to disclose. JB: Nothing to disclose. PE: Nothing to disclose. RW: Nothing to disclose. AB: Nothing to disclose. AET: Nothing to disclose CPH: Nothing to disclose.
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