Surgical Site Infections

At JSS, we want to spotlight surgical site infections in spine, as they have a higher incidence than most other segments. While estimates range from as low as 2% all the way up to 13%, a 2016 study conducted by the Spine Research Institute at NYU Hospital for Joint Diseases suggests that actual incidence is near the higher end of these estimates, around 12.7%.

The study followed 314 patients through instrumented spinal surgery and found that forty acquired surgical site infections in accordance with CDC criteria for SSIs. There was a mix of superficial and deep infections with treatments including antibiotics, drainings and five of the forty infections requiring operative revision.

Not only are these infections dangerous, but they are also quite costly. A study published in 2002 by the Division of Infectious Diseases at Duke University Medical Center concluded:

“Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life.”

With the government cracking down on facilities with high incidences of SSIs, the cost associated with these potentially deadly infections only continues to grow. No institutions, for-profit or non-for-profit, can afford the additional time and cost these infections impose.

We have found that the best ways to mitigate your risk for these infections is to bring on terminally sterile products and horizontal laminar airflow devices to protect your impants and incision. Many companies already provide terminally sterile implants, but still use reproccesed instruments; make sure the cannulated instruments are processed properly, as they are an especially welcoming environment for bioburden. Or, better yet, avoid this issure entirely by introducing terminally streile instruments when available

References:

McClelland S, Takemoto RC, Lonner BS, et al. Analysis of Postoperative Thoracolumbar Spine Infections in a Prospective Randomized Controlled Trial Using the Centers for Disease Control Surgical Site Infection Criteria. International Journal of Spine Surgery. 2016;10:14. doi:10.14444/3014.

Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The Impact of Surgical-Site Infections Following Orthopedic Surgery at a Community Hospital and a University Hospital Adverse Quality of Life, Excess Length of Stay, and Extra Cost. Infection Control & Hospital Epidemiology. 2002;23(4):183-189. doi:10.1086/502033

Additional Reading:

Della Volpe, K. (2019). Reprocessing of Pedicle Screws and Exposure in Sterile-Field Leads to Infection in Spinal Surgery |. [online] Orthospinenews.com. Available at: http://www.orthospinenews.com/2019/06/17/reprocessing-of-pedicle-screws-and-exposure-in-sterile-field-leads-to-infection-in-spinal-surgery/ [Accessed 24 Jun. 2019].

Agarwal A, Macmillan A, Goel V, Agarwal AK, Karas C. A Paradigm Shift Toward Terminally Sterilized Devices. Clinical Spine Surgery. 2018;31(7):308-311. doi:10.1097/bsd.0000000000000675.