Trends in Reoperation for Surgical Site Infection After Spinal Surgery With Instrumentation in a Multicenter Study
Kazuyoshi KobayashiShiro ImagamaKei AndoHiroaki NakashimaFumihiko KatoKoji SatoTokumi KanemuraYuji MatsubaraHisatake YoshiharaAtsuhiko HirasawaMasao DeguchiRyuichi ShinjoYoshihito SakaiHidenori InoueNaoki Ishiguro
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A multicenter retrospective analysis of a prospectively maintained database.To examine the characteristics of reoperation for surgical site infection (SSI) after spinal instrumentation surgery, including the efficacy of treatment for SSI and instrumentation retention.Aging of the population and advances in surgical techniques have increased the demand for spinal surgery in elderly patients. Treatment of SSI after this surgery has the main goals of eliminating infection and retaining instrumentation.The subjects were 16,707 patients who underwent spine surgery with instrumentation in 11 hospitals affiliated with the Nagoya Spine Group from 2004 to 2015. Details of those requiring reoperations for SSI were obtained from surgical records at each hospital.There were significant increases in the mean age at the time of surgery (54.6-63.7 years) and the number of instrumentation surgeries (726-1977) from 2004 to 2015. The incidence of reoperation for SSI varied from 0.9% to 1.8%, with a decreasing trend over time. Reoperation for SSI was performed in 206 cases (115 men, 91 women; mean age 63.2 years). The average number of reoperations (1.4 vs. 2.3, P < 0.05), time from SSI to first reoperation (4.3 vs. 9.5 days, P < 0.05), and the methicillin-resistant Staphylococcus identification rate (20% vs. 37%, P < 0.01) were all significantly lower in cases with instrumentation retention (n = 145) compared to those with instrumentation removal (n = 61).There were marked trends of aging of patients and an increase in operations over the study period; however, the incidences of reoperation and instrumentation removal due to SSI significantly decreased over the same period. Rapid debridement after SSI diagnosis may have contributed to instrumentation retention. These results can serve as a guide for developing strategies for SSI treatment and for improved planning of spine surgery in an aging society.3.Keywords:
Instrumentation
Surgical Site Infection
Spinal Surgery
Spinal Surgery
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Spinal Surgery
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Single-institutional, prospective observational study.To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI).Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated.A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated.In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery.In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI.4.
Surgical Site Infection
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In this multicenter retrospective observational study involving 58 562 adult patients hospitalized for COVID-19, melatonin use (N = 272) at a mean daily dose of 2.6 mg was not associated with reduced mortality.
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Spinal surgeries are a common procedure, but there is significant risk of adverse events following these operations. While the rate of adverse events ranges from 8% to 18%, surgical site infections (SSIs) alone occur in between 1% and 4% of spinal surgeries.
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The diagnoses, treatment, and clinical courses of 178 children with urethral valves were analyzed in a retrospective, multicenter study. In group I the diagnosis had been made during the first 1 weeks of life, in group II between the 2nd and 12th months of life, after which treatment was begun.
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Abstract Background Despite significant advancements in clinical aseptic techniques and wound infection control, surgical site infections (SSIs) continue to pose a significant risk and complication following spinal surgery. The use of intrawound antibiotics for the prevention of SSIs after spine surgery is a controversial method. Objective To conduct a review of the current literature on the use of antibiotics in wound care and evaluate their effectiveness in preventing postoperative SSIs. Methods Keywords such as “spinal surgery” or “spine”, “antibiotics”, “local” or “topical”, “prevention of infection”, and “infection” were used based on PubMed, Web of Science, Cochrane and Embase database. The literature was screened based on the title, abstract, full text reading, and extraction of relevant research data. Comparisons of the data were performed using RevMan 5.3 software. Results A total of 18922 patients from 24 studies were included in the final analysis, 8878 patients received antibiotics (experimental group) to prevent SSIs, and 10044 patients did not receive any additional antibiotics (control group). In the experimental group, 178 patients developed SSIs, compared to 356 patients in the control group. The results of the meta-analysis indicated that the incidence of SSIs in the experimental group was significant lower than that in the control group (95% confidence interval, 0.36-0.75, p=0.0004). Conclusion The topical application of antibiotics within the wound site is a crucial and efficient method to prevent SSIs after spinal surgery.
Spinal Surgery
Surgical Site Infection
Surgical wound
Wound infection
Aseptic processing
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