Object
Title: Risk factors as well as methods of preventing surgical site infection after the procedure of posterior spondylodesis
Abstract:
Introduction: The number of people suffering from pain in the backbone is increasing. Epidemiological data is alarming as staggering 75-85% of the world population are affected by spinal pain. The dynamics of pain can vary. Patient's functioning and activities become limited and more difficult as a result of pain. Patients may become disable and dependant on others for help every day. Back pain is in fact an interdisciplinary issue which is diagnosed and treated by neurologists, neurosurgeons, rheumatologists, orthopaedists, traumatologists, physiotherapists, and psychologists. Spinal surgical treatment includes a wide range of procedures, from minimally invasive ones to open skeletal immobilization surgeries. Despite high hygiene standards, and high standards during procedures, surgical site infection (SSI) is the most common complication, which results in numerous negative consequences. Nevertheless, theoretically SSI can be avoided. Aim of the paper: The aim of the paper was assessment of risk factors as well as methods of preventing surgical site infection after the procedure of posterior spondylodesis. Material and methods: The research method was analysis of medical records of patients after posterior spondylodesis. The main tool was proprietary evaluation sheet. First, individual records of patients who had undergone surgery at The Orthopedic-Rehabilitation Universit ; y Hospital in Zakopane, between 2014 and 2005, were analysed retrospectively. Thereafter, a database containing details of 763 patients was created. Originally, the patients had undergone scheduled posterior spondylodesis surgery (SFS). Medical records of the patients operated on between 2014 and 2016 were analysed from 2017 to 2018. The study group included patients with SSI. The control group included patients without SSI. Patients included in the study group needed to display symptoms of SSI as defined by European Centre for Disease Prevention and Control. Morbidity rate and a standardized risk index were used in the assessment of epidemiological situation in SSI among patients after spondylodesis surgery. Results/Findings: Surgical site infection, with the wound requiring revision surgery, was diagnosed in 89 patients (11,7%). Among children with SSI the incidence rate was 3,9%, whereas among adults it was 7,8%, OR 1,66 (95% CI 1,05 – 2,65). The probability of incidence of SSI among adult patients after SFS was 1,6 greater in comparison with the group of child patients (p<0,05). Statistically significant p < 0,05 relationship between the coincidence of SSI and patient's smoking status was observed. SSI morbidity among smokers was 20,4% and among non-smokers -11,6%, OR = 2,0 (95% CI 1,1 – 3,5), (p < 0,05). Statistically significant p < 0,01 relationship between the coin ; cidence of SSI and patient's unhealthy weight, high BMI was noted. SSI morbidity among patients with abnormal BMI was 14% whereas in individuals with normal BMI it was - 8%, and (OR) was 1,9 (95% CI 1,15 – 3,07). In the study group only 40 patients were diabetic and SSI morbidity among them was 30%. Odds ratio OR = 3,6 (95% CI 1,75 – 7,36), (p = 0,001). SSI morbidity among patients with neuromuscular diseases was 27% whereas in individuals without neuromuscular disease it was only 10%. (OR) was 3,1 (95% CI 1,78 – 5,77) and a statistically significant result (p<0,001). Median follow up for the surgery was longer for patients with SSI than for those undergoing SFS without SSI. Duration of the procedure FUSN > 75 percentile was also extended among the patients with SSI, respectively 225 minutes for children and 228 minutes for adults. Analysis of logistic regression revealed statistically significant relationship between extended time of the surgery by every 15 minutes and the incidence of SSI, p = 0,001. The probability of incidence of SSI among patients after FUSN with the surgery time extended by every 15 minutes was (OR) 1,10 (95% CI 1,03 – 1,16) what signifies that with almost 95% certainty extending FUSN surgery time by 15 minutes increased the probability of incidence of SSI by 1,10 among the patients. Analysis of univariate logistic regression revealed that the older the p ; atient was, the probability of incidence of SSI was 1,06 times higher, OR=1,06 (95% CI 1,01 – 1,11) (p < 0,05). Some patients may require further wound revision surgeries. Hospitalisation time for the patients with SSI, who needed surgical wound revision surgery, was extended. Additionally, some of those patients required further surgical treatment of SSI and consequently additional hospitalisation. Conclusions: Sex of the patients did not have significant influence, statistically speaking, on the SSI incidence after the procedure of FUSN, whereas patients' age had statistically significant influence on the SSI incidence (SSI, the older the patient was the greater the probability of SSI). Patients' habits and lifestyle (smoking, diet) had influence on the risk of SSI. What is statistically significant, those of the patients who were smokers developed SSI more often than the non-smokers. Furthermore, obese and overweight patients were at a double risk of developing SSI infection after FUSN procedure, in comparison to the patients with normal body weight. Abnormal body weight (too low or too high), as measured by BMI, had statistically significant influence on the SSI incidence. Surgery time exceeding 75 percentile had statistically significant influence on the SSI incidence. Standardised infection ratio SIR for FUSN among a group of patients with one risk factor exceeded cumu ; lative morbidity rate, according to Nosocomial Infection Surveillance System, which indicates that more SSI cases were observed than it had been expected. The retrospective analysis of medical records revealed numerous shortcomings in documentation of medical procedures, which needs to be a cause for improvement and a basis for creating algorithms for procedures in documentation.
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Rada Dyscypliny Nauki o zdrowiu
Promoter:
Gniadek, Agnieszka ; Wałaszek, Marta
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Last modified:
Mar 22, 2024
In our library since:
Dec 12, 2022
Number of object content hits:
135
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65
All available object's versions:
http://dl.cm-uj.krakow.pl:8080/publication/4904
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| Edition name | Date |
|---|---|
| ZB-136015 | Mar 22, 2024 |
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