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Evaluating the Risk of Postoperative Infection and Complications in Lumbar Spine Surgery Patients with Preoperative

Sri Tummala1,2, Drew Haslam3, David Gibbs3

  • 1Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, USA. sr1@tamu.edu.

Archives of Orthopaedic and Trauma Surgery
|August 19, 2025
PubMed
Abstract

Insights

Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization significantly increases the risk of mortality and complications, including infections and organ injury, following elective lumbar spine surgery (LSS). Early identification and decolonization protocols are crucial for high-risk patients undergoing LSS.

Area of Science:

  • Orthopaedic surgery
  • Infectious disease epidemiology
  • Patient safety

Background:

  • Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections (SSIs) in orthopaedic procedures.
  • The impact of MRSA colonization on a broad spectrum of postoperative complications in elective lumbar spine surgery (LSS) has not been fully elucidated.

Purpose of the Study:

  • To evaluate the association between preoperative MRSA colonization and a comprehensive set of 30-day postoperative outcomes in patients undergoing elective LSS.
  • To identify risk factors for MRSA colonization in this patient population.

Main Methods:

  • Retrospective cohort study utilizing the TriNetX multi-institutional database.
  • Inclusion of 440,336 patients undergoing elective LSS, stratified into MRSA-colonized (n=3,711) and non-colonized groups.
  • Propensity score matching (1:1) to balance cohorts based on demographics and comorbidities, followed by calculation of risk ratios (RR) for primary outcomes.

Main Results:

  • MRSA-colonized patients demonstrated significantly higher risks for wound complications (superficial SSI, deep SSI, wound dehiscence), systemic infections (sepsis, pneumonia), and hematologic/renal events (transfusion, anemia, acute kidney failure).
  • All-cause mortality was 2.05-fold higher in MRSA-colonized patients.
  • Obesity, diabetes, tobacco use, malnutrition, and chronic kidney disease (CKD) were identified as independent predictors of MRSA colonization.

Conclusions:

  • Preoperative MRSA colonization is independently linked to substantially increased risks of mortality, wound complications, systemic infections, hematologic morbidity, and acute renal injury after elective LSS.
  • Preoperative identification of MRSA colonization warrants implementation of decolonization strategies and patient counseling on heightened risks.
  • A risk-stratified approach can optimize perioperative management and enhance outcomes for LSS patients with MRSA colonization.
Keywords:
S. aureusComplicationsLumbar spine surgeryMethicillin-resistant Staphylococcus aureusOutcomesSurgical site infection

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