Factors associated with post-operative sepsis following surgery for spinal tumors: An analysis of the ACS-NSQIP database.
Malik AT, Jain N, Scharschmidt TJ, Mayerson JL, Khan SN
Clin Neurol Neurosurg 172 1-7 09/01/2018
OBJECTIVES: Sepsis is a rare but potentially devastating complication when it occurs after surgery for spinal tumors. Given the morbidity associated with sepsis, we sought to collate evidence using a large national surgical database to identify the incidence, pre-operative predictors and post-operative factors associated with sepsis following spinal tumor surgery.
PATIENTS AND METHODS: The 2005-2014 ACS-NSQIP database was queried for patients undergoing surgery for spinal tumors using ICD-9 codes for primary (170.2, 170.6, 213.2, 213.6) or secondary (198.3, 198.4 and 198.5) spinal tumor. Data were then filtered to include patients who underwent a laminectomy, corpectomy and/or spinal fusion for the tumor. A total of 1468 patients were included in the final cohort. Pre-operative risk factors were assessed using univariate regression models while adjusting for the occurrence of missing variables. Post-operative infectious sources such as urinary tract infection (UTI), pneumonia and surgical site infection were assessed for any association with the occurrence of sepsis.
RESULTS: A total of 44 patients (3.0%) had an episode of sepsis within 30 days after surgery. Independent pre-operative factors significantly associated with the occurrence of sepsis were history of prior systemic inflammatory response syndrome (SIRS) (OR 2.89 [95% CI 1.3-6.2]), presence of Insulin-dependent Diabetes Mellitus (IDDM) (OR 3.52 [95% CI 1.4-8.7] and a length of stay>8 days (OR 2.5 [95% CI 1.0-6.2]). Independent infectious sources associated with occurrence of sepsis were surgical site infection (SSI) (OR 23.3 [95% CI 8.6-63.7]), pneumonia (OR 5.8 [95% CI 2.2-15.2]) and urinary tract infection (UTI) (OR 14.7 [95% CI 5.96-36.1]). Up to 52% of the cases of sepsis were associated with at least one source of infection (UTI, pneumonia or SSI) with UTI being the most common (29.5%) followed by pneumonia (22.7%) and SSI (18%).
CONCLUSION: Three percent of patients following surgery for spinal tumor experience an episode of sepsis within 30 days. The most likely sources of sepsis include UTI, pneumonia and SSI. Pre- and post-operative targeted interventions in these high risk patients will be most beneficial in reducing the incidence, morbidity and mortality from sepsis after surgery for spinal tumors.