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Nutritional program reduces elderly patients’ surgical site infection rates

Issue: November 2010

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After the orthopedic department at Imakiire General Hospital in Japan introduced a simple nutritional program for their elderly patients undergoing spine surgery in 2006, they saw a marked drop in rates of surgical site infections in that group. The program included checking dental hygiene and overall nutrition before surgery — particularly before instrumented surgery — and improving it as much as possible.

“Nutritional support team management should be introduced for SSI [surgical site infection] prevention in elderly patients with spine surgery,” Shunji Matsunaga, MD, PhD, of Kagoshima, Japan, said at the 2010 Annual Congress of the Spine Society of Europe (EuroSpine 2010).

Matsunaga and colleagues decided to study this area after they noticed that not only were there an increasing number of spine surgeries, but that they were being performed more often in elderly patients, a group at added risk for surgical site infection (SSI). Once the help of a nutritional support team (NST) was enlisted, the researchers also sought to evaluate the effectiveness of that protocol for SSI prevention in elderly patients who were 65 years or older.

These patients represented 424 of the 927 patients who underwent spine surgery at Matsunaga’s hospital from 2000 to 2008, he said.

Investigators found the rates of spine surgery increased in elderly patients from 29% in 2000 to 48% in 2008 with 19 SSIs (4.5%) associated with those procedures.

Furthermore, the rates of SSI among all instrumented cases were high, including those in the elderly.

What gave Natsunaga and colleagues the idea to take a nutritional approach to reducing SSI rates was the significantly low levels of serum protein prior to surgery observed in the elderly group, particularly men.

After the implementation of the NST program, the investigators found the SSI incidence in older patients at the hospital steadily dropping from 3.75% in 2006 to 3% in 2008.

Matsunaga S. Paper #34.

We still can operate on the elderly with fusion, but you should take care of any matters of nutrition, especially in the elderly. They will benefit from a nutrition program to fight infection, which may be a common problem affecting our elderly population.

– Joerg Franke, MD

Magdeburg, Germany, EuroSpine session moderator