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Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusions

Canadian Journal of Surgery, 2022-12, Vol.65, p.S132-S132 [Peer Reviewed Journal]

Copyright CMA Impact, Inc. Dec 2022 ;ISSN: 0008-428X ;EISSN: 1488-2310

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  • Title:
    Local contamination is a major cause of early deep wound infections following open posterior lumbosacral fusions
  • Author: Roeos, Brett ; Cherry, Ahmed ; Rampersaud, Raja ; Davidson, Bela ; Rabinovitch, Lily ; Nielsen, Christopher ; Jiang, Fan ; Vaisman, Alon ; Lewis, Stephen
  • Subjects: Confidence intervals ; Infections ; Pathogens
  • Is Part Of: Canadian Journal of Surgery, 2022-12, Vol.65, p.S132-S132
  • Description: Background: Postoperative surgical site infection in patients treated with lumbosacral fusion has been believed to be caused by perioperative contamination (perioperative inside-out infections) in patients with comorbidities. With the proximity of these incisions to the perianal region and limited patient mobility in the early postoperative period, local contamination from gastrointestinal and/or urogenital flora (postoperative outside-in infections) should be considered as a major source of complication. Methods: We conducted a single-centre, retrospective review of adult patients treated with open posterior lumbosacral fusions between January 2014 and January 2021. We aimed to identify common factors in patients experiencing deep postoperative infections. Oncologic, minimally invasive, primary infection and index procedures carried out at other institutions were excluded. Results: We identified 489 eligible patients, 20 of whom required débridement deep to the fascia (4.1%). Mean age (62.9 v. 60.8 yr), operative time (420 v. 390 min), estimated blood loss (1772 v. 1790 mL) and median levels fused (8.5 v. 9) were similar between the infected and noninfected groups. There was a higher percentage of patients with deformity (75% v. 29%) and increased body mass index (32.7 v. 28.4) in the infected group. The mean time from primary procedure to debridement was 40.8 days. Four patients showed no growth on culture. Three showed Staphylococcus species (perioperative inside-out infections) requiring débridement at a mean of 100.3 days (95% confidence interval 0-225 d). Thirteen patients showed infection with intestinal or urogenital pathogens (postoperative outside-in infections) requiring débridement at a mean of 20.0 days (95% confidence interval 9-31 d). Postoperative outside-in infections led to débridement 80.3 days earlier than perioperative inside-out infections (p = 0.007). Conclusion: In this series, 65% of deep infections were due to early local contamination by gastrointestinal and/or urogenital tracts pathogens. These infections were débrided significantly earlier than the Staphylococcus species infections. Owing to the proximity of the incisions to the perianal region, there should be increased focus on postoperative local wound management to ensure these pathogens are away from the wound during the critical stages of wound healing.
  • Publisher: Ottawa: CMA Impact, Inc
  • Language: English
  • Identifier: ISSN: 0008-428X
    EISSN: 1488-2310
  • Source: Geneva Foundation Free Medical Journals at publisher websites
    PubMed Central
    Alma/SFX Local Collection
    ProQuest Central
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