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Published on: June 23, 2020
Surgical site infection rates after minimally invasive spinal surgery
John E O'Toole1, Kurt M Eichholz, Richard G Fessler
1Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA. john_otoole@rush.edu
Object:
Postoperative surgical site infections (SSIs) have been reported after 2-6% of spinal surgeries in most large series. The incidence of SSI can be < 1% after decompressive procedures and > 10% after instrumented fusions. Anecdotal evidence has suggested that there is a lower rate of SSI when minimally invasive techniques are used.
Methods:
A retrospective review of prospectively collected databases of consecutive patients who underwent minimally invasive spinal surgery was performed. Minimally invasive spinal surgery was defined as any spinal procedure performed through a tubular retractor system. All surgeries were performed under standard sterile conditions with preoperative antibiotic prophylaxis. The databases were reviewed for any infectious complications. Cases of SSI were identified and reviewed for clinically relevant details. The incidence of postoperative SSIs was then calculated for the entire cohort as well as for subgroups based on the type of procedure performed, and then compared with an analogous series selected from an extensive literature review.
Results:
The authors performed 1338 minimally invasive spinal surgeries in 1274 patients of average age 55.5 years. The primary diagnosis was degenerative in nature in 93% of cases. A single minimally invasive spinal surgery procedure was undertaken in 1213 patients, 2 procedures in 58, and 3 procedures in 3 patients. The region of surgery was lumbar in 85%, cervical in 12%, and thoracic in 3%. Simple decompressive procedures comprised 78%, instrumented arthrodeses 20%, and minimally invasive intradural procedures 2% of the collected cases. Three postoperative SSIs were detected, 2 were superficial and 1 deep. The procedural rate of SSI for simple decompression was 0.10%, and for minimally invasive fusion/fixation was 0.74%. The total SSI rate for the entire group was only 0.22%.
Conclusions:
Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.
Insights
Minimally invasive spinal surgery significantly reduces the risk of surgical site infections (SSIs). This technique shows a 10-fold lower infection rate compared to traditional open spinal surgery, enhancing patient safety.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Infectious Disease
Background:
- Postoperative surgical site infections (SSIs) are a significant concern in spinal surgery, with reported rates varying widely.
- Incidence of SSIs ranges from <1% for decompressive procedures to >10% for instrumented fusions.
Observation:
- A retrospective review analyzed 1338 minimally invasive spinal surgeries (MISS) performed via tubular retractors.
- The study included patients with an average age of 55.5 years, predominantly undergoing lumbar procedures for degenerative conditions.
- Infections were meticulously tracked, with detailed review of any identified SSIs.
Findings:
- The overall SSI rate for minimally invasive spinal surgery was remarkably low at 0.22%.
- Specific rates included 0.10% for simple decompression and 0.74% for instrumented fusion/fixation.
- This represents a potential 10-fold reduction in SSIs compared to published data on open spinal surgery.
Implications:
- Minimally invasive spinal surgery techniques appear to substantially decrease the incidence of postoperative wound infections.
- These findings suggest that adopting MISS could lead to improved patient outcomes and reduced healthcare costs associated with SSIs.
- Further research validating these results in larger, prospective studies is warranted.
