Infection prevention in cervical spine surgery.
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ABSTRACT:
SUBMITTER: Aleem IS
PROVIDER: S-EPMC7154345 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
Publications
Infection prevention in cervical spine surgery.
Aleem Ilyas S IS Tan Lee A LA Nassr Ahmad A Riew K Daniel KD
Journal of spine surgery (Hong Kong) 20200301 1
Surgical site infections (SSI) following cervical spine surgery can lead to significant patient morbidity and costs. Prevention of SSIs is multifactorial and can be divided in to preoperative patient optimization and intraoperative surgical factors. We performed a literature review to identify methods that can be used to prevent SSI development specifically in the cervical spine. We also present specific surgical pearls and techniques that have the potential to significantly decrease rates of ce ...[more]
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Project description:BackgroundAs the number of cervical spine procedures performed continues to increase, the need for revision surgery is also likely to increase. Surgeons need to understand the etiology of post-surgical changes, as well as have a treatment algorithm when evaluating these complex patients.Questions/purposesThis study aims to review the rates and etiology of revision cervical spine surgery as well as describe our treatment algorithm.MethodsWe used a narrative and literature review. We performed a MEDLINE (PubMed) search for "cervical" and "spine" and "revision" which returned 353 articles from 1993 through January 22, 2014. Abstracts were analyzed for relevance and 32 articles were reviewed.ResultsThe rates of revision surgery on the cervical spine vary by the type and extent of procedure performed. Patient evaluation should include a detailed history and review of the indication for the index procedure, as well as lab work to rule out infection. Imaging studies including flexion/extension radiographs and computed tomography are obtained to evaluate potential pseudarthrosis. Magnetic resonance imaging is helpful to evaluate the disc, neural elements, soft tissue, and to differentiate scar from infection. Sagittal alignment should be corrected if necessary.ConclusionsRecurrent or new symptoms after cervical spine reconstruction can be effectively treated with revision surgery after identifying the etiology, and completing the appropriate workup.
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Project description:Study Design Systematic review. Study Rationale As the length of stay after cervical spine surgery has decreased substantially, the feasibility and safety of outpatient cervical spine surgery come into question. Although minimal length of stay is a targeted metric for quality and costs for medical centers, the safety of outpatient cervical spine surgery has not been clearly defined. Objective The objective of this article is to evaluate the safety of inpatient versus outpatient surgery in the cervical spine for adult patients with symptomatic or asymptomatic degenerative disc disease. Methods A systematic review of the literature was undertaken for articles published through February 19, 2014. Electronic databases and the bibliographies of key articles were searched to identify comparative studies evaluating the safety of inpatient versus outpatient surgery in the cervical spine. Spinal cord stimulation, spinal injections, and diagnostic procedures were excluded. Two independent reviewers assessed the strength of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, and disagreements were resolved by consensus. Results Five studies that met the inclusion criteria were identified. One study reported low risk of hematoma (0% of outpatients and 1.6% of inpatients). Two studies reported on mortality and both reported no deaths in either group following surgery. Dysphagia risks ranged from 0 to 10% of outpatients and 1.6 to 5% of inpatients, and infection risks ranged from 0 to 1% of outpatients and 2 to 2.8% of inpatients. One study reported that no (0) outpatients were readmitted to the hospital due to a complication, compared with four inpatients (7%). The overall strength of evidence was insufficient for all safety outcomes examined. Conclusion Though the studies in our systematic review did not suggest an increased risk of complication with outpatient cervical spine surgery, the strength of evidence to make a recommendation was insufficient. Further study is needed to more clearly define the role of outpatient cervical spine surgery.
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Project description:Background and objectivesThe anterior approach for cervical discectomy and fixation is a valuable procedure for decompression of the spinal cord in patients with severe canal stenosis and stabilization of cervical vertebral column. Although some studies have investigated the thyroid complications especially in cervical cancer surgery or recently in tracheostomy, little research has been performed on the anterior spine surgery so far. The present study aimed to evaluate possible changes in the thyroid in patients experiencing anterior cervical approaches for degenerative diseases.Materials and methodsSeventy patients who were undergoing anterior cervical spine surgery were selected and their demographic information was recorded, including age, sex, weight, body mass index (BMI), and medical records. Thyroid hormones (TSH, free T4, and free T3) were measured before surgery and three months after surgery.ResultsMost patients had cervical disc herniation (60%). The mean duration of surgery was 71.9 ± 8.36 minutes (range: 60-90 minutes). Twenty-one patients (30%) had anterior plating while 49 patients (70%) did not. Spearman's correlation coefficient was used to examine the correlation of the following variables with TSH changes: Number of operated cervical levels, level of operated spine, incision type, duration of surgery, type of surgery (ACDF or ACCF). None of these variables showed a significant correlation. Meanwhile, a significant and direct correlation was observed between TSH changes and age.ConclusionsAlthough the results of our study did not show any signs of functional changes due to thyroid tissue injury during surgery, based on rare case reports and age-related laboratory changes, we recommend thyroid function tests for diagnosing subclinical thyroid dysfunction before anterior cervical spine surgery in patients with degenerative diseases and especially in older adults.
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Project description:Study Design Retrospective database analysis. Objective The purpose of this study is to investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after cervical spine surgery. Methods A total of 1,602,130 cervical spine surgeries from the Nationwide Inpatient Sample database from 2002 to 2011 were included. Patients were included for study based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for cervical spine surgery for degenerative spine diagnoses. Baseline patient characteristics were determined. Multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. Results Incidence of C. difficile infection in postoperative cervical spine surgery hospitalizations is 0.08%, significantly increased since 2002 (p < 0.0001). The odds of postoperative C. difficile infection were significantly increased in patients with comorbidities such as congestive heart failure, renal failure, and perivascular disease. Circumferential cervical fusion (odds ratio [OR] = 2.93, p < 0.0001) increased the likelihood of developing C. difficile infection after degenerative cervical spine surgery. C. difficile infection after cervical spine surgery results in extended length of stay (p < 0.0001) and increased hospital costs (p < 0.0001). Mortality rate in patients who develop C. difficile after cervical spine surgery is nearly 8% versus 0.19% otherwise (p < 0.0001). Moreover, multivariate analysis revealed C. difficile to be a significant predictor of inpatient mortality (OR = 3.99, p < 0.0001). Conclusions C. difficile increases the risk of in-hospital mortality and costs approximately $6,830,695 per year to manage in patients undergoing elective cervical spine surgery. Patients with comorbidities such as renal failure or congestive heart failure have increased probability of developing infection after surgery. Accepted antibiotic guidelines in this population must be followed to decrease the risk of developing postoperative C. difficile colitis.
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Project description:Retrospective administrative database analysis.To determine the impact of glycemic control on perioperative complications and outcomes in patients undergoing degenerative cervical spine surgery.Diabetes mellitus (DM) is a highly prevalent systemic disease that has been shown to increase morbidity and mortality after spine surgery. Few studies have demonstrated negative effects on patients with DM who undergo cervical spine procedures; however, whether glycemic control influences surgical outcome is still unknown.The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients who underwent cervical spine surgery for degenerative conditions were identified using the International Classification of Diseases Ninth Revision, Clinical Modification, codes. Three surgical cohorts were chosen: controlled diabetic, uncontrolled diabetic, and patients without diabetes. Patient demographics, surgical procedures, perioperative complications and postoperative outcomes were assessed.The prevalence of controlled and uncontrolled diabetic patients undergoing degenerative cervical spine surgery had been increasing significantly from 2002 to 2011. Compared with patients without diabetes, uncontrolled diabetic patients had significantly increased odds of respiratory, cardiac, and genitourinary complications. Uncontrolled diabetic patients also had significantly increased risk of pulmonary embolism and postoperative infection. Uncontrolled diabetic patients had increased risk of inpatient mortality (odds ratio = 6.39, 95% confidence interval = 4.09-10.00, P < 0.0001) and increased mean length of stay (almost 5 d) compared with nondiabetic patients. Similarly, controlled diabetic patients increased the odds of perioperative complications; however not nearly to the same degree. Controlled diabetic patients extended the mean length of stay by almost a day (P < 0.0001) and significantly increased costs compared with nondiabetic patients.Poor glycemic control increases the odds of inpatient mortality and perioperative complications in patients undergoing degenerative cervical spine surgery. Controlling DM before degenerative cervical spine surgery may lead to better outcomes and decreased costs.Therapeutic Level 3.
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