Risk factors for infection after orthopaedic spine surgery at a high-volume institution

Surgical site infections are associated with increased morbidity, mortality, and resource utilization. To identify risk factors for infection, the authors reviewed all orthopaedic spine operations at Duke University Medical Center from 2005 to 2010. Of the 3138 patients treated during the study period, 115 developed a surgical site infection (3.7%). Demographics, comorbidities, and perioperative blood glucose levels were analyzed in the infected and uninfected cohorts. History of myocardial infarction, congestive heart failure, renal disease, pneumonia, urinary tract infection, and diabetes mellitus (DM) were associated with a higher risk of infection. Notably, a diagnosis of DM nearly doubled the risk of infection. Even in patients without DM, perioperative blood glucose levels greater than 140 mg/dL doubled the risk of infection. The authors propose that strict blood glucose control in both DM and non-DM patients may significantly reduce the risk of infection after spinal surgery.