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Published on: June 23, 2020
Postoperative spinal deep wound infection: a six-year review of 3230 selective procedures
Chia-Hsiao Kuo1, Shih-Tein Wang, Wing-Kuang Yu
1Department of Orthopedics, Taipei Veterans General Hospital, Taiwan, ROC.
Background:
Postoperative wound infection remains a troublesome but common complication after spinal surgery. This study presents the 6-year experience of our surgical team with post-operative deep wound infection in Taipei Veterans General Hospital.
Methods:
Of 3230 selected operations, 72 cases of wound infection were identified. Thirty patients with deep wound infection were reviewed, including 17 men and 13 women at a mean age of 32 years. The pre-operative diagnoses included spondylolisthesis, scoliosis, spinal stenosis, herniated inter-vertebral disc, spinal fracture and adjacent syndrome.
Results:
In this report, different deep wound infection rates were compared between different operative procedures including (1) posterior decompression with fixation and fusion, 1.15%. (2) simple decompression (laminectomy) and disectomy, 0.37%, (3) revision fixation with decompression, 4.4%, and (4) removal of implant. 0.33%. The onset of infection sign was divided into 3 groups: (1) acute (< 2 weeks), 43.3%, (2) subacute (2-4 weeks), 40%, and (3) chronic (> 4 weeks), 16.6%. In 11 patients with deep wound infection, no bacteria was cultured, while 14 patients had Methicillin-resistant Staphylococcus aureus and another 3 patients had lower-grade toxic Staphylococcus aureus. All patients received debridement followed by delayed wound closure with effective antibiotics. Instruments were removed in only 8 patients. Twenty seven cases were cured after treatment but 3 patients expired in poor condition.
Conclusions:
In this series, total deep wound infection was 0.9% in our 6-year experience. The incidence of postoperative spinal infection increased with the complexity of the procedure. Most patients got completely disease free with antibiotics and surgical treatment.
Insights
Postoperative spinal wound infections occurred in 0.9% of surgeries over six years. More complex procedures correlated with higher infection rates, but most patients recovered with antibiotics and surgery.
Area of Science:
- Spinal Surgery
- Infectious Diseases
- Surgical Outcomes
Background:
- Postoperative wound infection is a common complication following spinal surgery.
- This study details a 6-year experience with deep wound infections at Taipei Veterans General Hospital.
Purpose of the Study:
- To analyze the incidence and characteristics of deep wound infections after spinal surgery.
- To identify risk factors and outcomes associated with postoperative spinal infections.
Main Methods:
- A review of 3230 spinal operations identified 72 wound infections, with 30 deep infections analyzed.
- Patient demographics, pre-operative diagnoses, operative procedures, and infection onset were recorded.
- Bacterial cultures, treatment protocols, and patient outcomes were assessed.
Main Results:
- The overall deep wound infection rate was 0.9%.
- Infection rates varied by procedure: posterior decompression with fixation/fusion (1.15%), simple decompression/discectomy (0.37%), revision fixation (4.4%), and implant removal (0.33%).
- Methicillin-resistant Staphylococcus aureus was the most common pathogen; 27 patients were cured, and 3 expired.
Conclusions:
- The incidence of deep spinal wound infection is 0.9% based on a 6-year experience.
- Increased surgical complexity is associated with a higher risk of postoperative infection.
- Effective antibiotic therapy and surgical intervention lead to favorable outcomes in most cases.