Related Experiment Videos
Intraoperative fraction of inspired oxygen is a modifiable risk factor for surgical site infection after spinal
Lisa L Maragakis1, Sara E Cosgrove, Elizabeth A Martinez
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Lmaraga1@jhmi.edu
Background:
Surgical site infections (SSI) after spinal surgery increase morbidity, mortality, length of hospital stay, and costs. Most previously identified risk factors for these infections, such as severity of illness and procedure duration, are not amenable to intervention. This study sought to identify modifiable risk factors associated with SSI after spinal surgery.
Methods:
This is a case-control study including case identification and review of medical records. A total of 104 patients with SSI after spinal surgery were compared to 104 randomly selected control patients without SSI after spinal surgery in a 926-bed tertiary care hospital in Baltimore, Maryland, between April 1, 2001 and December 31, 2004.
Results:
Multivariate analysis identified independent risk factors for SSI after spinal surgery including prolonged procedure duration (odds ratio [OR], 4.7; 95% confidence interval [95% CI], 1.6-14; P < 0.001), American Society of Anesthesiologists score of 3 or greater (OR, 9.7; 95% CI, 3.7-25; P < 0.001), lumbar-sacral operative level (OR, 2.9; 95% CI, 1.2-7.1; P = 0.02), posterior approach (OR, 3.5; 95% CI, 1.2-9.7; P = 0.02), instrumentation (OR, 2.5; 95% CI, 1.1-6.0; P = 0.03), obesity (OR, 4.0; 94% CI, 1.6-10; P < 0.01), razor shaving before surgery (OR, 3.6; 95% CI, 1.2-11; P = 0.02), and intraoperative administered fraction of inspired oxygen of less than 50% (OR, 12; 94% CI, 4.5-33; P < 0.001).
Conclusions:
In addition to previously reported risk factors, this study identified intraoperative administered fraction of inspired oxygen of less than 50% as an independent, modifiable risk factor for SSI after spinal surgery. Intraoperative administration of at least 50% fraction of inspired oxygen should be tested prospectively as an intervention to prevent SSI after spinal surgery.
Insights
Surgical site infections (SSI) after spinal surgery are linked to modifiable factors like low intraoperative oxygen levels. Administering at least 50% fraction of inspired oxygen may help prevent these infections.
Area of Science:
- Spinal Surgery
- Infectious Disease Prevention
- Anesthesiology
Background:
- Surgical site infections (SSI) following spinal surgery are associated with increased patient morbidity, mortality, hospital stay, and costs.
- Many identified risk factors for SSI, such as illness severity and procedure length, cannot be modified.
- This study aimed to identify actionable, modifiable risk factors for SSI in spinal surgery patients.
Purpose of the Study:
- To identify modifiable risk factors for surgical site infections (SSI) after spinal surgery.
- To provide evidence for targeted interventions to reduce SSI rates in spinal surgery.
Main Methods:
- A case-control study design was employed.
- 104 patients with SSI after spinal surgery were compared to 104 matched controls without SSI.
- Data were collected via medical record review at a tertiary care hospital between 2001 and 2004.
Main Results:
- Independent modifiable risk factors for SSI included prolonged procedure duration, American Society of Anesthesiologists score ≥3, lumbar-sacral operative level, posterior approach, and instrumentation.
- Obesity and pre-operative razor shaving were also significant risk factors.
- Intraoperative administration of less than 50% fraction of inspired oxygen was a strong independent risk factor (OR, 12; P < 0.001).
Conclusions:
- Low intraoperative fraction of inspired oxygen (<50%) is a significant, modifiable risk factor for SSI after spinal surgery.
- This finding adds to previously known risk factors and suggests a new target for prevention.
- Prospective studies are warranted to evaluate the efficacy of maintaining ≥50% fraction of inspired oxygen to prevent SSI.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...
01:23Peripheral Artery Disease V: Postoperative Nursing Management