Sat., 10/20/07 Pediatrics/Spine, Paper #64, 3:47 pm OTA-2007
Postoperative Infections in Fractures of the Spine: A Review of 340 Consecutive Cases at a Level I Trauma Center
Gregory M. Mundis, MD (n); John T. Glomset, BS (n); Timothy A. Puckett, MD, DC (n);
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Purpose: Our objectives were first, to report the incidence of postoperative infection on the largest series in the literature among patients with acutely stabilized spine fractures; second, identify modifiable risk factors to prevent infection; and third, to analyze in detail the nature and treatment of these infections. Our hypothesis is that patients with significant preoperative comorbidities including neurologic deficit, longer operative times, extensive instrumentation, and longer intensive care unit (ICU) stays will have a higher infection rate.
Methods: 340 consecutive patients with acutely stabilized spine fractures with a minimum of 1-year follow-up were identified. Patients were retrospectively reviewed and data collected on demographics, preoperative, intraoperative, and postoperative characteristics. Microbiologic data was collected for all infected cases including treatment of infection.
Results: 23 infections were identified among 340 patients (6.7%). No statistical difference was identified in the demographic data, use of steroids, medical comorbidities, and body mass index. Average ISS among infected patients is 34, and 19 among those not infected (P <0.001). Average ICU stay was 13.5 days among infected patients and 7.5 days among those not infected (P <0.05). Neurologic injury occurred in 43.5% of the infected group and 55.5% among those not infected (P <0.05). Average time passed to definitive treatment was 9.9 days in the infection group versus 5.1 days in the control (P <0.05). Preoperative albumin was 2.6 mg/dL versus 3.3 mg/dL among those not infected (P <0.05). Intraoperative data showed no difference between the two groups in regards to number of levels instrumented, operative time, blood loss, and use of drain. Postoperative ICU stay was significantly shorter in the noninfected group, and no difference was found in the development of remote infections. Enterobacter was most commonly identified, followed by methicillin-sensitive Staphylococcus aureus and methicillin-resistant S aureus. 11 of 23 patients had gram-negative infections. 12 of 23 had multiorganism involvement. All were treated with 6 weeks of antibiotics.
Conclusion: We report a 6.7% infection rate among 340 acutely operated spine fractures. To our knowledge this is the largest series reported. Prolonged ICU stay, delay greater than 5 days, and nutritional status were found to be significant risk factors. Neurologic injury and number of levels instrumented were not significantly different among the groups.
Significance: We recommend operating within 5 days of injury, monitoring perioperative nutritional status, and considering gram-negative coverage for all operative spine fractures.If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.