Trends in Reoperation for Surgical Site Infection After Spinal Surgery With Instrumentation in a Multicenter Study

Area of Science:

• Spine Surgery
• Infectious Diseases
• Surgical Outcomes

Background:

• The aging population and surgical advancements increase demand for spinal instrumentation surgery.
• Treatment of surgical site infection (SSI) aims to eradicate infection and retain instrumentation.
• Spinal surgery in elderly patients presents unique challenges for SSI management.

Purpose of the Study:

• To analyze reoperation characteristics for SSI after spinal instrumentation.
• To evaluate the efficacy of SSI treatment and instrumentation retention strategies.
• To identify trends in SSI management in an aging patient population.

Main Methods:

• Multicenter retrospective analysis of a prospectively maintained database.
• Involved 16,707 patients undergoing spine surgery with instrumentation across 11 hospitals (2004-2015).
• Detailed review of surgical records for patients requiring reoperation due to SSI.

Main Results:

• The incidence of reoperation for SSI showed a decreasing trend from 0.9% to 1.8% over the study period.
• Reoperation for SSI occurred in 206 cases, with significantly fewer reoperations and shorter time to treatment in cases with instrumentation retention.
• Methicillin-resistant Staphylococcus (MRSA) rates were lower in patients with retained instrumentation.

Conclusions:

• Despite an aging patient population and increased surgical volume, reoperation and instrumentation removal rates due to SSI significantly decreased.
• Rapid debridement following SSI diagnosis appears to be a key factor in successful instrumentation retention.
• Findings provide guidance for SSI treatment strategies and planning for spine surgery in aging populations.