Koutsoumbelis et al identified risk factors associated with surgical site infection (SSI) following posterior lumbar instrumented arthrodesis. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Hospital for Special Surgery in New York City.
Patient selection: posterior lumbar instrumented arthrodesis
Outcome: surgical site infection
Prophylactic antibiotics were given within 1 hour of surgery (using cefazolin) and for 24 hours after surgery.
Risk factors for SSI from multivariate logistic regression:
(1) obesity (BMI >= 30 kg per square meter)
(2) comorbidities
(2a) diabetes mellitus
(2b) COPD
(2c) osteoporosis
(2d) coronary artery disease
(3) estimated blood loss > 500 mL
(4) dural tear
(5) >= 10 people in the operating room
where:
• It is not clearly stated if the patient was included in the total number of people in the OR. The patient is included in the implementation. It was also not clear if this was the maximum number at any one time or reflected people rotating into the room.
• Methicillin resistant Staphylococcus aureus was the most common pathogen (in 35% of cases).
Additional factors that may affect risk:
(1) prolonged operation
(2) transfusion of packed red blood cells
(3) infusion of crystalloid
(4) female gender (in the univariate analysis)
