Postoperative Supine Position Increases the Risk of Infection After Spinal Surgery by Posterior Approach

Area of Science:

• Orthopedic Surgery
• Infectious Disease Control

Background:

• Posterior approach spine surgeries exhibit higher infection rates.
• The supine position is hypothesized to contribute to infection via poor hygiene and muscle trauma.
• Circulatory impairment in the supine position may also increase infection risk.

Purpose of the Study:

• To investigate the impact of patient positioning on deep wound infection rates in posterior spine surgery.
• To determine if the supine position is a modifiable risk factor for postoperative infections.

Main Methods:

• A randomized controlled trial involving 106 patients undergoing posterior spine surgery.
• Patients were allocated to either lateral decubitus position only or a combination of dorsal and lateral decubitus positions.
• Deep wound infection diagnosis followed U.S. Centers for Disease Control and Prevention criteria, with follow-up up to 360 days.

Main Results:

• Postoperative deep wound infection occurred in 11.3% of patients, with Streptococcus aureus being the most common pathogen.
• The incidence of deep wound infection was significantly higher in the control group (receiving supine positioning).
• The difference in infection rates between groups was statistically significant (P=0.004).

Conclusions:

• The supine position is significantly associated with an increased risk of wound infection after posterior spine surgery.
• Avoiding the supine position is a potential modifiable strategy to decrease postoperative spine infection rates.
• This finding has implications for surgical protocols aimed at enhancing patient safety.