Sleiman Haddad1,2, Susana Núñez-Pereira3, Carlos Pigrau4, Dolors Rodríguez-Pardo4, Alba Vila-Casademunt5, Ahmet Alanay6, Emre R Acaroglu7, Frank S Kleinstueck8, Ibrahim Obeid9, Francisco Javier Sanchez Perez-Grueso10, Ferran Pellisé4. 1. Hospital Universitari de la Vall d'Hebron, Barcelona, Spain. haddadsleiman@gmail.com. 2. Universitat Autonoma de Barcelona, Barcelona, Spain. haddadsleiman@gmail.com. 3. Hospital Universitario Donostia, Donostia, Spain. 4. Hospital Universitari de la Vall d'Hebron, Barcelona, Spain. 5. Vall dHebron Institute of Research (VHIR), Barcelona, Spain. 6. Acibadem University School of Medicine, Istanbul, Turkey. 7. Ankara ARTES Spine Center, Kavaklidere, Turkey. 8. Department of Spine Surgery, Schulthess Clinic, Zuerich, Switzerland. 9. CHU Bordeaux Pellegrin Hospital, Bordeaux, France. 10. Hospital de La Paz, Madrid, Spain.
Abstract
PURPOSE: The impact of deep surgical site infection (SSI) on surgical outcomes after adult spinal deformity (ASD) surgery is still unclear. We aimed to study the morbidity of SSI in ASD and its impact on deformity correction and functional outcome. METHODS: Prospective multicenter matched-cohort study including consecutively enrolled ASD patients. Patients developing SSI were matched to similar controls in terms of age, gender, ASA, primary or revision, extent of fusion, and use of tri-columnar osteotomies. Preoperative parameters, surgical variables, and complications were recorded. Deformity parameters and Health Related Quality of Life (HRQoL) scores were obtained preoperatively and at 6, 12, and 24 months. Independent t test and Fischer's exact test were used for comparisons. RESULTS: 444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter. CONCLUSION: SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it's negative impact seems to be diluted by the second postoperative year as differences in HRQoL scores between the two groups decrease. These slides can be retrieved under Electronic Supplementary material.
PURPOSE: The impact of deep surgical site infection (SSI) on surgical outcomes after adult spinal deformity (ASD) surgery is still unclear. We aimed to study the morbidity of SSI in ASD and its impact on deformity correction and functional outcome. METHODS: Prospective multicenter matched-cohort study including consecutively enrolled ASDpatients. Patients developing SSI were matched to similar controls in terms of age, gender, ASA, primary or revision, extent of fusion, and use of tri-columnar osteotomies. Preoperative parameters, surgical variables, and complications were recorded. Deformity parameters and Health Related Quality of Life (HRQoL) scores were obtained preoperatively and at 6, 12, and 24 months. Independent t test and Fischer's exact test were used for comparisons. RESULTS: 444 surgical ASDpatients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter. CONCLUSION: SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it's negative impact seems to be diluted by the second postoperative year as differences in HRQoL scores between the two groups decrease. These slides can be retrieved under Electronic Supplementary material.
Entities:
Keywords:
Adult spinal deformity; Clinical outcome; Complication; Deep surgical site infection; Scoliosis; Surgery
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