Torakolomber transpediküler vida ile posterior stabilizasyon uygulanan hastalarda cerrahi alan enfeksiyonu gelişiminin prospektif takibi / Prospective follow-up of surgical site infection in patients undergoing posterior stabilization with thoracolumbar transpedicular screw
AdvisorPROF. DR. FEYZA KARAGÖZ GÜZEY
MetadataShow full item record
OBJECTIVE: To determine the rate of surgical site infection in patients who underwent posterior stabilization with thoracolumbar transpedicular screws, to determine the risk factors in the development of surgical site infection, to investigate the effectiveness of bathing the instruments with antibiotic solution in preventing the development of infection. GENERAL INFORMATION: Surgical site infection prolongs the patient's hospital stay and increases morbidity and mortality. When hospital expenses are calculated, a patient who develops osteomyelitis costs at least 4 times more than a patient who is only stabilized. The increase in the use of metal implants in spine surgery in the last 15 years has brought along an increase in postoperative infection rates. In the literature, the frequency of spinal infections after surgery is around 1%, while it has been reported between 1-13% when a metal is used. This reveals that there is a serious relationship between the use of instruments and the development of infection. Staphylococcus aureus is the most common (60%) isolated bacterium in postoperative spinal infections. However, in most cases there is an infection with more than one organism. Bacteria are transported and adhered when implanted on the surface of instruments or during a temporary bacteremia. Microorganisms in biofilm layers cause resistance to both antimicrobial therapy and host defense. Some risk factors have been reported in the literature, such as diabetes mellitus, cardiovascular diseases, advanced age, malignant disease, obesity, trauma, revision surgery, excessive blood loss, use of allografts, and excessive operating room traffic. Laboratory tests used in the follow-up of surgical site infection; leukocyte count, erythrocyte sedimentation rate and C-reactive protein. The incidence of surgical site infection has decreased with the use of prophylactic antibiotics. MATERIAL and METHOD: In this study; 239 patients who underwent posterior stabilization with transpedicular screws between March 2006 and June 2009 in our clinic were prospectively studied for at least 21 days and at most 2 years in terms of infection. Various risk factors were evaluated for each patient. Instruments were applied to 104 selected cases by washing them with Vancomycin HCl - Ceftriaxone disodium hemiheptahydrate dissolved in 200 cc isotonic serum and the effectiveness of this procedure in preventing infection development was investigated. RESULTS and DISCUSSION: The rate of surgical site infection in 239 patients was 12.6% (n: 30). Superficial infection (8.4%) was detected in 20 patients, and deep infection (4.2%) was detected in 10 patients. Patients with a diagnosis of vertebral fracture, patients with a blood sugar of 140 mg / dL and above, patients with first degree diabetic relatives, patients with an additional disease, patients without paraplegic and sphincter control, patients whose surgery lasted longer than 4 hours, patients who used allograft bone chips, patients with more than 1200 cc of instrumentation, patients with dural injury, patients with preoperative hemoglobin value below 12.2 g / dL, patients with urinary catheter for more than 2 days, patients with additional intervention and surgery patients followed up in the intensive care unit; the surgical area was found to be risky for the development of infection. C-reactive protein was found to be elevated in patients with surgical site infections. More than one microorganism was isolated in 12 patients with culture growth. Staphylococcus aureus was observed in 10 patients (45.4%). Wound debridement was performed in 8 (26.7%) of 30 patients with infection. In 4 patients (13.3%), the instrumentation system was removed due to deep infection. One of the 239 cases was lost due to sepsis due to surgical site infection. CONCLUSION: One of the most common and important complications after spine surgery is infections. The goal should be to prevent infection before it occurs. For this, risk factors should be determined and minimized and prophylactic methods should be developed. Today, both clinical and experimental studies are ongoing to prevent infections after spine surgery. In the coming years, the goal should be to develop instruments with better biocompatibility and lower infection rates. In our study, bathing the instruments with antibiotics and applying them to the patient was found to be statistically significant in preventing deep infections.