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Practice pattern variables could be the secret to reducing surgical-site infections in spine surgery
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NEW ORLEANS — Closely investigating the number of variables in practice patterns could be the key to lowering the frequency of already-rare surgical-site infections in spinal surgery, according to a presentation here.
Michelle Marks, NMD, presented her findings at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.
The purpose of her study was to investigate possible routes for lowering surgical-site infections (SSI) rates in spinal surgery in accordance with United States governmental guidelines.
“In the eyes of a spine surgeon, this proposal posed a daunting task: to try and eradicate an already rare event,” she said.
Study parameters and findings
For the study, Marks attempted to define the current SSI rate in adolescent idiopathic scoliosis (AIS) surgical cases.
“Multiple studies have reported on the rates of delayed and postoperative infection after the surgical correction of spinal deformity in adolescent idiopathic scoliosis,” she said. “However, these are reports from single institutions – and some with a single surgeon case series.”
Marks and her colleagues reviewed patients from multiple centers who underwent surgical correction of AIS. The investigators classified the severity of the infection as those which required operative debridement (deep) vs. those treated with local wound care and oral antibiotics (superficial).
Of 1,657 patients, 28 (1.7%) were diagnosed with an acute SSI. Eighteen (1.1%) were considered superficial and 10 (0.6%) deep. The investigators found no correlation between SSI rates and perioperative variables such as surgical approach, operative time, blood loss, length of hospitalization or implant material.
Variation in the rate of SSI among the study group centers ranged from 0% to 3.6%, Marks reported.
“Room to improve”
According to Marks, the answer for reducing SSI rates may lie in factors that are not closely monitored.
“Factors such as OR traffic, cleaning practices of scrubs, use of shoe covers vs. OR shoes, CHG pre-wash vs. Betadine prep, antibiotic prophylaxis and patient body temperature are just a few examples of variables that may contribute to SSI occurrence yet are not strictly monitored in order to determine if they are indeed risk factors,” she said.
“There may be room to improve our SSI rates” she added. “Further investigation is required to evaluate the outcomes of changes in practice patterns to further understand identified risk factors associated with SSI.”
- Reference:
Marks M, Newton PO, Betdz RR, et al. Surgical site infection (SSI) in spinal surgery: The newest never event. Paper #72. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
