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Risk of Surgical Site Infection and Mortality Following Lumbar Fusion Surgery in patients with Chronic Steroid Usage and Chronic MRSA infection.
Spine 2018 September 18
STUDY DESIGN: Retrospective database analysis among Medicare beneficiaries OBJECTIVE.: To determine the effect of chronic steroid use and chronic Methicillin Resistant Staphylococcus Aureus (MRSA) infection on rates of surgical site infection and mortality in patients 65 years of age and older who were treated with lumbar spine fusion.
SUMMARY OF BACKGROUND DATA: Systemic immunosuppresssion and infection focus elsewhere in the body are considered risk for surgical site infection (SSI). Chronic steroid use and previous MRSA infection have been associated with increased risk of SSI in some surgical procedures, but their impact on the risk of infection and mortality after lumbar fusion surgery has not been studied in detail.
METHODS: The PearlDiver insurance based database (2005-2012) was queried to identify 360,005patients over 65 years of age who had undergone lumbar spine fusion. Of these patients, those who had been taking oral glucocorticoids chronically and those with a history of chronic MRSA infection were identified. The rates of surgical site infection (SSI) and mortality in these two cohorts were compared to an age- and risk-factor matched control cohort and odds ratio was calculated.
RESULTS: Chronic oral steroid use was associated with significantly increased risk of 1 year mortality (OR = 2.06, 95%CI 1.13-3.78 p = 0.018) and significantly increased risk of SSI at 90 days (OR = 1.74, 95%CI 1.33-1.92 p < 0.001) and 1 year (OR = 1.88, (95%CI 1.41-2.01 p < 0.001). Chronic MRSA infection was associated with significantly increased risk of SSI at 90 days (OR = 6.99, 995%CI 5.61-9.91 p < 0.001) and 1 year (OR = 24.0, 95%CI 22.20-28.46 p < 0.001) but did not significantly impact mortality.
CONCLUSIONS: Patients over 65 years of age who are on chronic oral steroids or have a history of chronic MRSA infection are at significantly increased risk of surgical site infection following lumbar spine fusion.
LEVEL OF EVIDENCE: 3.
SUMMARY OF BACKGROUND DATA: Systemic immunosuppresssion and infection focus elsewhere in the body are considered risk for surgical site infection (SSI). Chronic steroid use and previous MRSA infection have been associated with increased risk of SSI in some surgical procedures, but their impact on the risk of infection and mortality after lumbar fusion surgery has not been studied in detail.
METHODS: The PearlDiver insurance based database (2005-2012) was queried to identify 360,005patients over 65 years of age who had undergone lumbar spine fusion. Of these patients, those who had been taking oral glucocorticoids chronically and those with a history of chronic MRSA infection were identified. The rates of surgical site infection (SSI) and mortality in these two cohorts were compared to an age- and risk-factor matched control cohort and odds ratio was calculated.
RESULTS: Chronic oral steroid use was associated with significantly increased risk of 1 year mortality (OR = 2.06, 95%CI 1.13-3.78 p = 0.018) and significantly increased risk of SSI at 90 days (OR = 1.74, 95%CI 1.33-1.92 p < 0.001) and 1 year (OR = 1.88, (95%CI 1.41-2.01 p < 0.001). Chronic MRSA infection was associated with significantly increased risk of SSI at 90 days (OR = 6.99, 995%CI 5.61-9.91 p < 0.001) and 1 year (OR = 24.0, 95%CI 22.20-28.46 p < 0.001) but did not significantly impact mortality.
CONCLUSIONS: Patients over 65 years of age who are on chronic oral steroids or have a history of chronic MRSA infection are at significantly increased risk of surgical site infection following lumbar spine fusion.
LEVEL OF EVIDENCE: 3.
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