Postoperative wound infection after instrumentation of thoracic and lumbar fractures.

OBJECTIVE: To assess the risk of infection in trauma patients undergoing surgical intervention with instrumentation for thoracic and lumbar fractures. DATA SOURCES: A case series of 235 consecutive patients who sustained thoracic and lumbar fractures seen at Tampa General Hospital in Tampa, Florida between 1986 and 1997. STUDY SELECTION: 117 patients of the 235 consecutive patients included in the case series underwent surgical intervention; of these patients, twelve were identified as having acute postoperative wound infections. DATA EXTRACTION: Of those patients treated with operative decompression and internal fixation, the authors identified and studied those with an acute wound infection. These patients were analyzed for risk factors and infection management. DATA SYNTHESIS: Twelve (10 percent) patients with acute postoperative wound infections were identified. These included nine deep and three superficial infections. This provides an overall infection rate of 10 percent (12 of 117). Of these, there were three infections in twenty-one patients undergoing anterior spinal procedures. Only two of the twelve patients had pure cultures of gram-positive organisms (2 Staphylococcus aureus). Cultures from eight (67 percent) patients showed multiple organisms. There was a significantly (P < 0.05) higher risk of infection in the patients with a complete neurologic injury 41 percent (7/17) as compared with those with no deficit or incomplete injuries 5.0 percent (5/100).
CONCLUSIONS: The overall risk of infection is higher in the trauma patient than in the elective surgery population. Those patients with a complete neurologic deficit are at a greater risk. Aggressive and early intervention can help contribute to a favorable outcome.