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Objectives To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery. Design Prospective observational study. Setting Academic medical center. Participants Individuals aged 70 and older undergoing spine surgery (N = 89). Measurements Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method ( CAM), CAM for the Intensive Care Unit, Delirium Rating Scale-Revised-98, and chart review. Hospital-based outcomes were obtained from the medical record and hospital charges from data reported to the state. Results Thirty-six participants (40.5%) developed delirium after spine surgery, with 17 (47.2%) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio ( OR) = 3.66, 95% confidence interval ( CI) = 1.48-9.04, P = .005), higher quintile of hospital charges ( OR = 3.49, 95% CI = 1.35-9.00, P = .01), and lower odds of discharge to home ( OR = 0.22, 95% CI = 0.07-0.69, P = .009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home. Conclusion Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal. [ABSTRACT FROM AUTHOR]

Study Design: Descriptive, retrospective cohort analysis., Objective: To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery., Summary of Background Data: SSI after spine surgery is frequently seen. Small case control studies have been published reporting the results of treatment options of SSI. We performed this study to identify the most common clinical and laboratory presentation of a SSI, the most frequently seen infective organism, and evaluate the effectiveness of current treatment., Methods: All patients who underwent spinal surgery at our institution for diagnosis other than infection between June 1996 and December 2005 (N=3174) were reviewed. All cases of SSI were identified. Patient and operative characteristics were reviewed. Infection type (deep or superficial), treatment course, laboratory and culture results were abstracted., Results: A total of 132 cases of SSI (84 deep and 48 superficial) were identified. About 72.7% of the SSI were detected as outpatients an average 28.7 days (deep, 29.9; superficial, 25.2) after the index procedure. Wound drainage was the most common complaint (68.2%). C-reactive protein level was elevated in 98.0%, erythrocyte sedimentation rate was elevated in 94.4%, but only 48.6% had elevated white blood cell count. Staphylococcus aureus was isolated in 72.6% of deep and 85.7% of superficial positive cultures. Seventy-six percent of deep SSI could be treated with a single debridement to clear the SSI. Instrumentation was retained or primarily exchanged if loose in all cases. Around 72.9% of superficial SSI were treated without formal debridement in the operating room. Antibiotic treatment was longer in deep SSI (40.8 vs. 19.6 days)., Conclusion: Deep SSI following spinal surgery was effectively treated with single stage debridement and intravenous antibiotics. Superficial SSI could be treated effectively with local wound care and oral antibiotic therapy.

Study Design: A retrospective cohort study to identify rates and analyze the risk factors for postoperative spinal wound infection., Objective: To determine significant risk factors for postoperative spinal wound infection by comparing those patients who developed a postoperative wound infection with the rest of the cohort., Summary of Background Data: A surgical site infection (SSI) is a common complication after spinal surgery. SSI leads to higher morbidity, mortality, and healthcare costs. To develop strategies to reduce the risk for SSI, independent risk factors for SSI should be identified., Methods: The electronic patient record of all 3174 patients who underwent orthopedic spinal surgery at out institution were abstracted. Individual patient and perioperative characteristics were stored in an electronic database., Results: In total, 132 (4.2%) patients were found to have an SSI with 84 having deep based infection. Estimated blood loss over 1 liter (P = 0.017), previous SSI (P = 0.012) and diabetes (P = 0.050) were found to be independent statistically significant risk factors for SSI. Obesity (P = 0.009) was found to significantly increase the risk of superficial infection, whereas anterior spinal approach decreased the risk (P = 0.010). Diabetes (P = 0.033), obesity (P = 0.047), previous SSI (P = 0.009), and longer surgeries (2-5 hours [P = 0.023] and 5 or more hours [P = 0.009]) were found to be independent significant risk factors for deep SSI., Conclusion: SSI is commonly seen after spinal surgery. In our study, we identified independent risk factors for both deep and superficial SSI. Identification of these risk factors should allow us to design protocols to decrease the risk of SSE in future patients.