Naoya Tsubouchi1, Shunsuke Fujibayashi2, Bungo Otsuki2,3, Masanori Izeki2,4, Hiroaki Kimura5,6, Masato Ota4, Takeshi Sakamoto7, Akira Uchikoshi8, Shuichi Matsuda2. 1. Department of Orthopedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihatake-cho, Fukakusa, Fushimi, Kyoto, 612-8555, Japan. ntsubouc@kyotolan.hosp.go.jp. 2. Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of Orthopedic Surgery, Kobe Central General Hospital Hospital, Kobe, Japan. 4. Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan. 5. Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan. 6. Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan. 7. Department of Orthopedic Surgery, Osaka Red Cross Hospital, Osaka, Japan. 8. Department of Orthopedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan.
Abstract
PURPOSE: Few studies have investigated the risk factors for implant removal after treatment for spinal surgical site infection (SSI). Therefore, there is no firmly established consensus for the management of implants. We aimed to investigate the incidence and risk factors for implant removal after SSI managed with instrumentation, and to examine potential strategies for avoiding implant removal. METHODS: Following a survey of seven spine centers, we retrospectively reviewed the records of 55 patients who developed SSI and were treated with reoperation, out of 3967 patients who had spinal instrumentation between 2003 and 2012. We examined implant survival rate and applied logistic regression analysis to assess the potential risk factors for implant removal. RESULTS: The overall rate of implant retention was 60% (33/55). A higher implant retention rate was observed for posterior cervical surgery than for posterior-thoracic/lumbar surgery (100 vs. 49%, P < 0.001). On univariate analysis, significant risk factors for implant removal included greater blood loss, delay of reoperation, and delay of intervention with effective antibiotics. Multivariate analysis revealed that a delay in administering effective antibiotics was an independent and significant risk factor for implant removal in posterior-thoracic/lumbar surgery (odds ratio 1.17; 95% confidence interval 1.02-1.35, P = 0.028). CONCLUSIONS: Patients with SSI who underwent posterior cervical surgery are likely to retain the implants. Immediate administration of effective antibiotics improves implant survival in SSI treatment. Our findings can be applied to identify SSI patients at higher risk for implant removal.
PURPOSE: Few studies have investigated the risk factors for implant removal after treatment for spinal surgical site infection (SSI). Therefore, there is no firmly established consensus for the management of implants. We aimed to investigate the incidence and risk factors for implant removal after SSI managed with instrumentation, and to examine potential strategies for avoiding implant removal. METHODS: Following a survey of seven spine centers, we retrospectively reviewed the records of 55 patients who developed SSI and were treated with reoperation, out of 3967 patients who had spinal instrumentation between 2003 and 2012. We examined implant survival rate and applied logistic regression analysis to assess the potential risk factors for implant removal. RESULTS: The overall rate of implant retention was 60% (33/55). A higher implant retention rate was observed for posterior cervical surgery than for posterior-thoracic/lumbar surgery (100 vs. 49%, P < 0.001). On univariate analysis, significant risk factors for implant removal included greater blood loss, delay of reoperation, and delay of intervention with effective antibiotics. Multivariate analysis revealed that a delay in administering effective antibiotics was an independent and significant risk factor for implant removal in posterior-thoracic/lumbar surgery (odds ratio 1.17; 95% confidence interval 1.02-1.35, P = 0.028). CONCLUSIONS:Patients with SSI who underwent posterior cervical surgery are likely to retain the implants. Immediate administration of effective antibiotics improves implant survival in SSI treatment. Our findings can be applied to identify SSI patients at higher risk for implant removal.
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