Abstract
Background
Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates.
Questions/purposes
(1) Is MIS associated with a lower incidence of SSI compared with open spinal surgery? (2) Are there other independent risk factors associated with SSI? (3) What bacteria are most common in spinal SSI?
Methods
Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion, laminectomy, or discectomy were analyzed and selected for a nested case-control analysis. Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case’s date of surgery. Patients were identified from an institutional database at a tertiary care hospital. MIS involved spinal procedures performed through a tubular retractor system. Univariate and multivariate analyses were performed.
Results
Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.0–32.7; p = 0.048). Also, from the multivariate regression model, diabetes (OR, 4.7; 95% CI, 1.3–17.0; p = 0.018), number of levels operated on (OR, 3.5; 95% CI, 1.6–7.5; p = 0.001), and body mass index (OR, 1.2; 95% CI, 1.0–1.3; p = 0.010) were predictive of an increased risk in SSI. Staphylococcus aureus was most frequently identified, being present in 12 of 21 (52.4%) patients in whom positive cultures were obtained. Four of the 12 patients had methicillin-resistant S aureus infection.
Conclusions
In our series, MIS has a lower incidence of SSI. The risk factors predictive of SSI should be further evaluated in well-designed prospective trials.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Acknowledgments
We thank Bennet Ong, Dr Vinaykumar M. Siddaraju, and Dr Ian Cheung for their assistance in data acquisition.
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One of the authors (WMY) certifies that he is a consultant to Medtronic (Singapore) and has received payment of benefits during the study period an amount of USD 10,000 to USD 100,000. Also he is a consultant to DePuy-Synthes (Singapore) and has received payment of benefits during the study period, an amount of less than USD 10,000. In addition, he receives fellowship support from Medtronic of an amount of USD 10,000 to USD 100,000 and fellow support from Depuy-Synthes of an amount of USD 10,000 to USD 100,000. Also, he has received a research grant from Medtronic for an unrelated topic of an amount of USD 10,000 to USD 100,000.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Ee, W.W.G., Lau, W.L.J., Yeo, W. et al. Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery?. Clin Orthop Relat Res 472, 1718–1724 (2014). https://doi.org/10.1007/s11999-013-3158-5
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DOI: https://doi.org/10.1007/s11999-013-3158-5