Article
Management and outcome of postoperative surgical site infection in patients with posterior (thoraco-)lumbar instrumentation – analysis of 125 surgeries
Postoperative Wundinfekte bei Patienten mit dorsaler (thorako-)lumbaler Spondylodese – Behandlung und Outcome nach125 Operationen
Search Medline for
Authors
Published: | May 8, 2019 |
---|
Outline
Text
Objective: The management of surgical site infection (SSI) in patients with posterior spinal instrumentation is challenging. Evidence on the most appropriate treatment and the need for removal of implants is equivocal. We sought to evaluate the management and outcome of such patients at our institution.
Methods: We searched our in-house databases of prospectively documented surgeries and infectious diseases for eligible patients (01/2008–06/2018). Patient files were reviewed for patient age, gender, BMI, smoking status, medical history, details of surgery (duration, local antibiotics, debridement and implant retention (DAIR), partial vs complete (+cage) implant removal), causative pathogens, antimicrobial treatment, and outcome. Infection outcome was assessed in patients with ≥1yr follow-up (FU) (healed=no revision & no suspected signs of infection; surgical failure (sf) =non-septic revision; relapse=readmission for septic revision; new infection=new pathogen on septic revision; resolved=healed & sf). Patient-reported outcome (PRO) was documented with the Core Outcome Measures Index (COMI) (measures pain, function, well-being, quality of life, disability).
Results: 92 patients (39.1% male; 66.7±12.6 y; BMI 28.9±5.4 kg.m-2, 30.4% smokers) underwent 125 revisions for 97 SSI. Mean time between index and revision surgery was 28 d (7d–11y). Deep subfascial infection was diagnosed intraoperatively in 85/125 (68%). The most common pathogens were Staphylococcus epidermidis (n=40, 32%), and Staphylococcus aureus (n=32, 25.6%), or polymicrobial (n=14, 11.2%). DAIR was performed in 75/125 (60.0%) cases and partial removal in 43/125 (34.4%). In 22/97 SSI (22.7%), persistent infection required multiple revisions (≤4). Surgery was followed by intravenous and oral antimicrobial treatment for 10–12 weeks. In the 61 SSI (62.7%) with ≥1-yr FU, infection was resolved in 43 (70.5%); relapse occurred in 5 of the remaining 18 cases (relapse rate: 8.2%). 2 patients (2.1%) died due to uncontrolled infection. COMI reduced significantly (p<0.001) from 8.0±1.6 before the index operation to 4.2±2.8 one year later, and 81.5% patients were satisfied with their care.
Conclusion: Patients with SSI after posterior spinal instrumentation can be successfully treated in most cases with optimal surgical and antibiotic treatment. Loose implants should be removed and in some cases multiple revisions may be necessary. Patient outcomes are satisfactory. The results will serve for future patient information.