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Risk Factors for Spinal Surgical-Site Infections in a Community Hospital: A Case–Control Study

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak ,
Marilyn Jones ,
Brian M. Waterman ,
Cathy M. Carroll ,
Robert Bernardi  and
Victoria J. Fraser
Anucha Apisarnthanarak
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marilyn Jones
Affiliation:
Infection Control Department, BJC Health Care System, St. Louis, Missouri
Brian M. Waterman
Affiliation:
Infection Control Department, BJC Health Care System, St. Louis, Missouri
Cathy M. Carroll
Affiliation:
Infection Control Department, BJC Health Care System, St. Louis, Missouri
Robert Bernardi
Affiliation:
Neurosurgery Division, BJC Health Care System, St. Louis, Missouri
Victoria J. Fraser*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Ave., St. Louis, MO 63110
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Abstract

Objective:

To characterize risk factors for surgical-site infection after spinal surgery.

Design:

A case–control study.

Setting:

A 113-bed community hospital.

Method:

From January 1998 through June 2000, the incidence of surgical-site infection in patients undergoing laminectomy, spinal fusion surgery, or both increased at community hospital. A We compared 13 patients who acquired surgical-site infections after laminectomy, spinal fusion surgery, or both with 47 patients who were operated on during the same time period but did not acquire a surgical-site infection. Information collected included demographics, risk factors, personnel involved in the operations, length of hospital stay, and hospital costs.

Results:

Of 13 case-patients, 9 (69%) were obese, 9 (69%) had spinal compression, 5 (38.5%) had a history of tobacco use, and 4 (31%) had diabetes. Oxacillin-sensitive Staphylococcus aureus (6 of 13; 46%) was the most common organism isolated. Significant risk factors for postoperative spinal surgical-site infection were dural tear during the surgical procedure and the use of glue to cement the dural patch (3 of 13 [23%] vs 1 of 47 [2.1%] ; P = .02) and American Society of Anesthesiologists risk class of 3 or more (6 of 13 [46.2%] vs 7 of 47 [15%]; P = .02). Case-patients were more likely to have prolonged length of stay (median, 16 vs 4 days; P < .001). The average excess length of stay was 11 days and the excess cost per case was $12,477.

Conclusion:

Dural tear and the use of glue should be evaluated as potential risk factors for spinal surgical-site infection. Systematic observation for potential lapses in sterile technique and surgical processes that may increase the risk of infection may help prevent spinal surgical-site infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 31 - 36
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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