Case-control study of risk factors for surgical site infection after three-column osteotomy for spine deformity

AIM: To investigate risk factors for surgical site infection (SSI) after three-column osteotomy (3CO) for spinal deformity. MATERIAL and METHODS: The American College of Surgeons National Surgical Quality Improvement Program database (2012- 2014) was reviewed. We included adult patients who underwent 3CO and compared pertinent cases (SSI) to controls (no SSI) in terms of preoperative and operative characteristics. Patients with clean/contaminated, contaminated, and dirty/infected wounds were excluded. A stepwise multivariate regression was used to identify independent predictors of SSI, with results presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: There were 293 patients who underwent 3CO for spinal deformity, out of whom 15 (5.1%) developed a SSI during the 30- day follow-up period. Of the 15 patients with SSI, 10 underwent reoperation (66.7%) within 30 days. Compared to controls, patients in the SSI group were more likely to be obese (p=0.030), have a higher American Society of Anesthesiologists (ASA) physical status class (p=0.051) and be more likely to undergo multilevel 3CO (p=0.013). After controlling for obesity, bleeding disorder, deformity type, ASA class, preoperative anemia, and multilevel procedures, Class II obesity (OR 4.98; 95% CI, 1.24 - 19.94; p=0.023) and multilevel 3CO (OR 4.71; 95% CI, 1.30 - 16.94; p=0.018) were significant predictors of SSI occurrence. CONCLUSION: Patients with Class II obesity and patients who undergo multilevel osteotomy may be at a significantly increased risk of developing a SSI within 30 days after 3CO for spine deformity.