Epidemiology of postoperative spinal wound infection in the Middle East and North Africa (MENA) region

Sameh M Abolfotouh; Mohamed Khattab; Atiq Uz Zaman; Omar Alnori; Alaa Zakout; Faisal Konbaz; Tarek El Hewala; Ghazwan Hassan; Sami Al Eissa; Mostafa A Abolfotouh

doi:10.1016/j.xnsj.2023.100222

Epidemiology of postoperative spinal wound infection in the Middle East and North Africa (MENA) region

N Am Spine Soc J. 2023 Apr 23:14:100222. doi: 10.1016/j.xnsj.2023.100222. eCollection 2023 Jun.

Authors

Sameh M Abolfotouh^{1

2}, Mohamed Khattab³, Atiq Uz Zaman⁴, Omar Alnori⁵, Alaa Zakout⁵, Faisal Konbaz⁶, Tarek El Hewala⁷, Ghazwan Hassan⁸, Sami Al Eissa⁶, Mostafa A Abolfotouh⁹

Affiliations

¹ Medcare Orthopedics and Spine Hospital, Dubai, United Arab Emirates.
² OrthoCure Medical Center, Dubai, United Arab Emirates.
³ Orthopedics Department, Ain Shams University, Cairo, Egypt.
⁴ Orthopedics and Spine Surgery Department, Lahore Medical and Dental College, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
⁵ Orthopedics Department, Hamad General Hospital, Doha, Qatar.
⁶ King Abdulaziz Medical City (KAMC), National Guard Health Affairs, Riyadh, Saudi Arabia.
⁷ Spine Unit, Orthopedics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
⁸ Royal Private Hospital Baghdad, Baghdad, Iraq.
⁹ King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin-Abdulaziz University for Health Sciences (KSAU-HS)/King Abdulaziz Medical City (KAMC), Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

Abstract

Background: Despite the extensive literature on postoperative spinal wound infection, yet to our knowledge, there is no previous study containing combined data from several sites in the Middle East and North Africa (MENA) region. This study aimed to estimate the incidence of surgical site infection (SSI) following spine surgeries, its associated factors, and management.

Methods: In a retrospective cohort study, medical records of all patients ≥18 years of age who underwent spine surgery at 6 tertiary referral centers in the MENA region between January 2014 to December 2019 (n=5,872) were examined to collect data on the following: (1) Patient's characteristics, (2) Disease characteristics, (3) Spine surgery approach, and (4) Characteristics of Postoperative SSI. The determinants of postoperative SSI were identified using logistic regression analysis. Receiver operating characteristic (ROC) curve was applied to identify the cut-off of the length of stay in the hospital postoperatively till the infection is likely to occur. Significance was set at p<.05.

Results: The overall incidence of SSI was 4.2% (95% CI: 3.72-4.77), in the form of deep (46.4%), superficial (43.1%), dehiscence (9.3%), and organ space (1.2%) infections. After adjusting for all possible confounders, significant predictors of postoperative SSI were; diabetes (OR=2.12, p<.001), smoking (OR=1.66, p=.002), revision surgery (OR=2.20, p<.001), open surgery (OR=2.73, p<.001), perioperative blood transfusion (OR=1.45, p=.033), ASA class III(OR=2.08, p=.002), and ≥4 days length of stay "LOS" (OR= 1.71, p=.001). A cut-off of 4 days was the optimum LOS above which postoperative SSI is more likely to occur, with 0.70 sensitivity, 0.47 specificity, and 0.61 area under the curve.

Conclusions: This is the first study that highlighted the incidence of postoperative SSI in spine surgery in the MENA region. Incidence figures are comparable to figures in different areas of the world. Identifying predictors of SSI might help high‑risk patients benefit from more intensive wound management.

Keywords: Complications; Degenerative; Incidence; Instrumentation; Risk factors; Spine; Surgical-site infection; Traumatic; Treatment.