Risk factors for surgical site infection in the patient with spinal injury

Study Design. A retrospective chart review of 1561 patients with spinal injury was conducted over a 4-year period. Objectives. To determine the rate of surgical site infection in the spinal trauma population, to compare infection rates after spinal operations for elective and traumatic indications, and to identify risk factors for postoperative wound infections in the traumatic subpopulation. Summary of Background Data. Surgical site infection after spinal operations is a dreaded complication. Risk factors have been investigated previously, but the subset of patients with acute traumatic spinal injury may be distinct. Methods. The hospital's infection control program was used to identify surgical site infections after spinal operations, and infection rates were calculated. Data including patient characteristics, severity of injury indicators, surgical factors, and perioperative management factors were collected for the patients presenting with acute spinal injury over a 4-year period. Results. Postoperative wound infections developed in 24 of 256 patients. This infection rate of 9.4% was significantly (P < 0.001) higher than for elective spinal operations during the same period (3.7%). Risk factors found to be independently significant included delay until operation, increased postoperative intensive care unit stay, single (neurosurgical or orthopedic) versus combined operative team. Conclusions. Risk factors for surgical site infection in the acute trauma setting are identified. Two surgical teams may be involved without causing a higher rate of infection.