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Perioperative Catheter Use as a Risk Factor for Surgical Site Infection After Cervical Surgery: An Analysis of 39,893 Patients.

Abstract：

STUDY DESIGN:Retrospective cohort study. OBJECTIVE:To demonstrate the relationship between perioperative use of catheters and the incidence of surgical site infection (SSI) after cervical spine surgery, after adjusting for patient's age, severity of comorbidity, surgical approach, and use of instrumentation. SUMMARY OF BACKGROUND DATA:Although the association between SSI and the use of arterial catheters (ACs) or central venous catheters (CVCs) is established in cardiac surgery, the relation in the cervical spine was not well elucidated. METHODS:A private insurance database was analyzed. The incidence of SSI within 1 month postoperatively and the crude odds ratio (cOR) and 95% confidence interval (95% CI) were calculated based on the use of catheters. Subsequently, logistic regression analysis was performed to identify independent factors for SSI. Independent variables of the regression analysis included Charlson comorbidity index with the score of age, the use of CVC, the use of AC, surgical approach (anterior or posterior), and instrumentation (fusion or decompression alone). RESULTS:A total of 39,893 patients received cervical surgery between 2007 and 2015. Of these, 1.6% patients experienced an SSI. The incidence of SSI in patients treated with and without AC was 3.2% and 1.3%, respectively (cOR 2.44, 95% CI: 2.05-2.99, P < 0.001). Likewise, incidence of SSI in patients with and without CVC was 5.8% and 1.5%, respectively (cOR 2.61, 95% CI: 2.97-5.55, P < 0.001). Multivariate logistic regression analysis demonstrated that the adjusted OR was 1.66 in CVC use (95% CI: 1.08-2.46, P = 0.016), whereas the AC use was not significant variable (P = 0.086). CONCLUSION:The use of CVC can be a potential risk factor for SSI regardless of age, severity of comorbidity, surgical approach, or presence of instrumentation. Although the essential benefits of catheters are undisputed, our data can bring up the surgeon's attention to appropriate management of the CVC. LEVEL OF EVIDENCE:3.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Tamai K,Wang C,Heindel P,Paholpak P,Buser Z,Wang JC

doi

10.1097/BRS.0000000000002790

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

E157-E161

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-201902010-00008

journal_volume

pub_type

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Perioperative Catheter Use as a Risk Factor for Surgical Site Infection After Cervical Surgery: An Analysis of 39,893 Patients.