BACKGROUND CONTEXT

Despite the evidence in appendicular skeletal surgery, the effect of infection on spinal fusion remains unclear, particularly after Adult Spinal Deformity (ASD) surgery.

PURPOSE

The purpose of this study was to determine the impact of surgical site infection (SSI) in ASD surgery fusion rates and its association with other risks factors of pseudarthrosis.

STUDY DESIGN

We conducted an international multicenter retrospective study on a prospective cohort of patients operated for spinal deformity.

PATIENT SAMPLE

A total of 956 patients were included (762 females and 194 males).

OUTCOME MEASURES

Patient's preoperative characteristics, pre and postoperative spinopelvic parameters, surgical variables, postoperative complications and were recorded. Surgical site infections were asserted in case of clinical signs associated with positive surgical samples. Each case was treated with surgical reintervention for debridement and irrigation. Presence of pseudarthrosis was defined by the association of clinical symptoms and radiological signs of nonfusion (either direct evidence on CT-scan or indirect radiographic clues such as screw loosening, rod breakage, screw pull out or loss of correction). Each iterative surgical intervention was collected.

METHODS

Univariate and multivariate analysis with logistic regression models were performed to evaluate the role of risk factors of pseudarthrosis.

RESULTS

Nine hundred fifty-six surgical ASD patients with more than two years of follow-up were included in the study. 65 of these patients were treated for SSI (6.8%), 138 for pseudarthrosis (14.4%), and 28 patients for both SSI and pseudarthrosis.

On multivariate analysis, SSI was found to be a major risk factor of pseudarthrosis (OR=4.4; 95% CI=2.4,7.9) as well as other known risks factors: BMI (OR=1.1; 95% CI=1.0,1.1), smoking (OR=1.6; 95% CI=1.1,2.9), performance of Smith-Petersen osteotomy (OR = 1.6; 95% CI 1.0,2.6), number of vertebrae instrumented (OR=1.1; 95% CI=1.1,1.2) and the caudal level of fusion, with a distal exponential increment of the risk (OR max for S1=6, 95% CI=1.9,18.6).

CONCLUSION

SSI significantly increases the risk of pseudarthrosis with an OR of 4.4.

中文翻译：

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手术部位感染是成人脊柱畸形手术中发生假关节的主要危险因素

背景语境

尽管有四肢骨骼手术的证据，但感染对脊柱融合的影响仍不清楚，尤其是在成人脊柱畸形 (ASD) 手术后。

目的

本研究的目的是确定手术部位感染(SSI) 对 ASD 手术融合率的影响及其与假关节形成的其他危险因素的关联。

学习规划

我们对因脊柱畸形手术的前瞻性队列患者进行了一项国际多中心回顾性研究。

患者样本

总共包括 956 名患者（762 名女性和 194 名男性）。

结果测量

记录患者的术前特征、术前术后脊柱骨盆参数、手术变量、术后并发症。如果出现与阳性手术样本相关的临床症状，则断言手术部位感染。每个病例都接受了清创和冲洗的外科再干预治疗。假关节的存在由临床症状和非融合的放射学体征相关联（CT 扫描的直接证据或间接的放射学线索，如螺钉松动、杆断裂、螺钉拔出或矫正丢失）来定义。收集每个迭代手术干预。

方法

采用逻辑回归模型进行单变量和多变量分析，以评估假关节形成危险因素的作用。

结果

956 名随访超过两年的外科 ASD 患者被纳入该研究。其中 65 名患者因 SSI (6.8%) 接受治疗，138 名患者接受假关节治疗 (14.4%)，28 名患者同时接受 SSI 和假关节治疗。

在多变量分析中，发现 SSI 是假关节形成的主要危险因素 (OR=4.4; 95% CI=2.4,7.9) 以及其他已知的危险因素：BMI (OR=1.1; 95% CI=1.0,1.1 ) , 吸烟 (OR=1.6; 95% CI=1.1,2.9), Smith-Petersen 截骨术的表现 (OR = 1.6; 95% CI 1.0,2.6), 椎骨数量 (OR=1.1; 95% CI=1.1 , 1.2) 和尾部融合水平，风险呈远端指数增加（S1 的 OR 最大值 = 6，95% CI = 1.9,18.6）。

结论

SSI 显着增加假关节形成的风险，OR 为 4.4。