J Korean Soc Spine Surg.  2018 Sep;25(3):115-121. 10.4184/jkss.2018.25.3.115.

Risk Factors for Wound Infection in Spinal Surgery: A Focus on Diabetes Mellitus

• Shin HK
• Park JK
• Kim E
• Park JH
• Park SJ
• Ha SH
• Jeong HJ

• KMID: 2421603
• DOI: http://doi.org/10.4184/jkss.2018.25.3.115

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To identify risk factors for infection after spinal surgery. SUMMARY OF LITERATURE REVIEW: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity.
MATERIALS AND METHODS
From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients' age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type.
RESULTS
Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups.
CONCLUSIONS
Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery.

Keyword

Spinal surgery; Risk factor; Infection; Diabetes mellitus

MeSH Terms

Blood Glucose
Body Mass Index
Diabetes Mellitus*
Humans
Obesity
Retrospective Studies
Risk Factors*
Spinal Diseases
Transplants
Wound Infection*
Wounds and Injuries*
Blood Glucose

Figure

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  Fig. 1. A diagram of patient enrollment.

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  Fig. 2. Magnetic resonance imaging (sagittal view, axial view) shows osteomyelitis of the L3 vertebra body (A) and large fluid collection on both psoas muscles (B) in an 86-year-old patient who had posterior fusion from T12 to L3.

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