Preoperative in-room delay increases infection risk in spine surgery

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1. Preoperative in-room delay (known as anesthesia ready time or ART) of greater than 1 hour was an independent risk factor for surgical site infection (SSI) in spine surgery. 

2. Anterior approach, ASA class, number of operated levels, trauma or tumor, and length of case were all predictive of longer ART. 

Evidence Rating Level: 3 (Fair) 

Study Rundown:  In patients undergoing spine surgery, ART of greater than 1 hour significantly increases the risk of a SSI.  Longer ART allows greater opportunity for loss of sterile technique and contamination of the sterile field.  Preoperative planning should focus on strategies to reduce ART and maximize steps and procedures that can be performed prior to entering the operative theatre.  This study is limited to the experience of a single academic tertiary care center and only captured patients who returned or were reoperated on due to infection.  Underlying confounding variables such as procedure complexity that contribute to prolonged ART may also exist.  Nonetheless, the results of this study emphasize the importance of limiting ART in order to reduce surgical site infections in spine surgery.

Click to read the study in SPINE

Relevant Reading: Risk Factors for Surgical Site Infection Following Orthopaedic Spinal Operations

In-Depth [retrospective review]: This report identified 9259 consecutive patients who underwent spine surgery at a single institution from 2005 to 2009.  Patients with pre-existing infections or being treated for osteomyelitis/discitis were excluded, leaving 7991 in the final analysis.  Patients readmitted or reoperated for surgical site infection (SSI) confirmed by positive cultures (n=276) were included in this study.  Anesthesia ready time(ART) is defined as the number of minutes between in-room and incision time.  Other data collected included procedure type, ASA score, wound class(clean, clean contaminated, contaminated, dirty, infected), age, sex, and primary surgical service.  Mean ART was significantly greater in patients with SSI (68±20min) compared to those without (60.5±38.6) with a mean difference of 7.5 minutes(p=0.001).  Risk of SSI in patients with ART greater than 1 hour was 4.9% vs 2.3% in those with ART less than 1 hour.  Multivariate binary regression analysis showed ART of more than 1 hour to be an independent risk factor for SSI.  Multivariate regression analysis identified several statistically significant (p<0.001) risk factors for increased ART including:  anterior approach, anterior/posterior combined approach, ASA class, number of operated levels, trauma or tumor cases, and length of surgery.  

By Chaz Carrier and Allen Ho

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