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 highrisk patients benefit from more intensive wound management.
ABSTRACT
STUDY DESIGN: Cross-sectional survey. OBJECTIVES: This study aimed to investigate work-related neck pain among AO spine surgeons in different regions by estimating its prevalence, predictors, consequences, and management methods. METHODS: A cross-sectional survey of 411 spine surgeon members of AO spine was conducted during March-May 2021, using the Modified Nordic Questionnaire and the Neck Disability Index. Data on neck pain experience during the last 12 months and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of neck pain. Significance was set at P < .05. RESULTS: The 1-year neck pain was experienced by 66.7% of surgeons. According to the Neck Disability Index, more than one-half (52.8%) experienced disability due to neck pain of mild (45.5%), moderate (6.5%), and severe (.8%) grades. Neck pain was responsible for stopping work in 17.5% of surgeons, with a median of 3.5 (IQR, 2-7.8) days off work. One-half of the participants (56.3%) were treated by medical care, 31.5% by physiotherapy, and 16.5% requested rest days and sick leave. Physical stress (P < .001) and non-exercising (P = .04) were the significant predictors of neck pain. CONCLUSION: The 12-month prevalence of neck pain was high among spine surgeons, with an impact on activities of daily living, mainly of a mild degree, reported by one-half of surgeons. Physical stress was the only significant predictor, while sports practice was a protective factor against neck pain. Medication was the primary management adopted-an increased focus on pain prevention through improved workplace ergonomics and sports activity programs is recommended.
