Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

Brief review

이 논문은 퇴행성 척추질환으로 후방경유 요추 유합술을 시행한 817명의 환자 데이터를 리뷰하여 감염에 영향을 끼칠 수 있는 요소를 밝힌 논문 입니다.

감염과 연관된 요소를 밝히기 위해 ‘단계적 다변량 비례 위험도 회기 분석법’을 이용하였습니다.

결과적으로, 연령의 증가와 당뇨병, 비만, 이전의 척추수술 경험 및 재원일수의 증가 등이 후방 경유 요추 유합술 후의 감염의 위험성을 증가시킬 수 있는 요인으로 드러났습니다.

*Title: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases

퇴행성 척추질환으로 후방 경유 요추 유합술을 시행한 817명 환자들의 감염 위험성

*Authors: Kaisorn L. Chaichana, M.D., Mohamad Bydon, M.D., David R. Santiago-Dieppa, M.D., Lee Hwang, M.D., Gregory McLoughlin, M.D., Daniel M. Sciubba, M.D., Jean-Paul Wolinsky, M.D., Ali Bydon, M.D., Ziya L. Gokaslan, M.D., and Timothy Witham, M.D.Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

*Bibliography: J Neurosurg Spine 20:45–52, 2014

Summary of Background

Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure.

Object

To ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections.

Methods

▶Subject: patients underwent instrumented posterior lumbar fusion for degenerative spine disease (1993~2010)

“Stepwise multivariate proportional hazards regression analysis” was used to identify factors associated with infection.

Variables with p < 0.05 were considered statistically significant.

Results

▶Total subjects: 817 patients underwent lumbar fusion

▶Infection patients: 37(4.5%)

-21 (57%) required operative intervention but only 3 (8%) required instrumentation removal as part of their infection management.

▶The factors independently associated with an increased risk of infection.

1) increasing age (RR 1.004 [95% CI 1.001–1.009], p = 0.049)

2) diabetes (RR 5.583 [95% CI 1.322–19.737], p = 0.02)

3) obesity (RR 6.216 [95% CI 1.832–9.338], p = 0.005)

4) previous spine surgery (RR 2.994 [95% CI 1.263–9.346], p = 0.009)

5) increasing duration of hospital stay (RR 1.155 [95% CI 1.076–1.230], p = 0.003)

Conclusions

-older age, diabetes, obesity, prior spine surgery, and length of hospital stay: independently associated with an increased risk of infection in lumbar fusion for degenerative spine disease

-The overwhelming majority of these patients were treated effectively without hardware removal.