Surgical Site Infection, Microbiology, and Antibiotic Utilization After Posterior Cervical Spinal Decompression and Fusion: A 10-Year Experience

Study DesignRetrospective cohort analysis.ObjectivesSurgical site infection (SSI) is a major complication following spine surgery. This is especially true with posterior cervical spinal surgery, contributing to increased hospital stay, socioeconomic burden, morbidity, and mortality. This study aimed to investigate risk factors for cervical SSI, identify organisms responsible, and characterize antibiotic treatment regimens to inform surgeons.MethodsA retrospective review of patients who underwent posterior cervical decompression and fusion (PCDF) was performed at a single academic quaternary care center. Outcome variables included SSI, culture speciation, and antibiotic regimens. Associations between demographic, clinical, and surgical factors with SSI were analyzed using univariate statistics and multiple logistic regression. A sub-analysis was conducted for gram-negative and gram-positive pathogens. P<0.05 was considered significant.ResultsIn 590 patients undergoing PCDF, 47 (8.0%) SSIs were identified, and average time to operative revision was 31.4 days. Coagulase-negative Staphylococcus (20, 42.6%), Staphylococcus aureus (17 [MRSA: 6, MSSA: 11], 36.2%), and Cutibacterium species (10, 21.3%) were most common. Eighteen (38.3%) SSIs were polymicrobial. Increased BMI was associated with SSI on univariate (p=0.018) and multivariate regression (p=0.021). Operative time was associated with increased risk of gram-negative infection (p=0.038).ConclusionSSI following PCDF remains a major complication with an incidence of 8%. Elevated BMI was an independent risk factor, underscoring importance of patient optimization. Longer operative time was associated with gram-negative infection in univariate analysis, however, this did not remain significant following multivariable adjustment. These findings highlight the need for awareness of resistant pathogens in tailoring empiric antibiotic regimens.