Surgical site infection after spinal surgery. Analysis of risk factors

Objetivo: Determinar la incidencia de infección del sitio quirúrgico (ISQ) en los pacientes intervenidos de cirugía raquimedular y analizar los factores de riesgo intrínsecos y extrínsecos. Material y métodos: Se realizó un estudio observacional retrospectivo en el Servicio de Neurocirugía del Hospital Universitario de La Ribera (Valencia, España) que abarcó el periodo 2005-2015, donde se incluyeron los enfermos que habían sido intervenidos de cirugía de columna y que desarrollaron ISQ hasta un año después de la intervención. Resultados: De un total de 2301 cirugías vertebromedulares realizadas en 2090 pacientes, 20 presentaron ISQ en un tiempo medio de 37,7 días, lo que supone una incidencia acumulada de infección del 0,87%. Destacan factores como el tiempo quirúrgico mayor de 3 horas (65%), la cirugía invasiva vía posterior con material de osteosíntesis por lesión traumática (55%) y la fístula de líquido cefalorraquídeo (5%). En relación a la evolución del paciente, fueron variables estadísticamente significativas la obesidad y las infecciones coexistentes (p=0,043; OR=2,00). Conclusión: La obesidad o la presencia de infecciones coexistentes en el paciente sometido a cirugía raquimedular causa el doble de probabilidad de exitus por ISQ.Objective: To determine the incidence of surgical site infection (SSI) in patients undergoing spinal surgery and to analyze the intrinsic and extrinsic risk factors. Material and methods: A retrospective observational study was conducted in the Neurosurgery Service of the University Hospital of La Ribera (Valencia, Spain), which covered the period 2005-2015, where all the patients who had undergone surgery for spinal surgery and who developed SSI until one year after the intervention. Results: Of a total of 2301 spinal surgeries performed in 2090 patients, 20 had SSI in a mean time of 37.7 days, which implies an accumulated infection incidence of 0.87%. Highlights factors such as surgical time over 3 hours (65%), posterior approach invasive surgery with osteosynthesis material for traumatic injury (55%) and cerebrospinal fluid fistula (5%). In relation to the evolution of the patient, obesity and coexisting infections was statistically significant (p=0.043, OR=2.00). Conclusion: Obesity or the presence of coexisting infections in the patient undergoing spinal surgery causes double the probability of exitus due to SSI

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Infección del sitio quirúrgico tras cirugía raquimedular. Análisis de los factores de riesgo

Objective: To determine the incidence of surgical site infection (SSI) in patients undergoing spinal surgery and to analyze the intrinsic and extrinsic risk factors. Material and methods: A retrospective observational study was conducted in the Neurosurgery Service of the University Hospital of La Ribera (Valencia, Spain), which covered the period 2005-2015, where all the patients who had undergone surgery for spinal surgery and who developed SSI until one year after the intervention. Results: Of a total of 2301 spinal surgeries performed in 2090 patients, 20 had SSI in a mean time of 37.7 days, which implies an accumulated infection incidence of 0.87%. Highlights factors such as surgical time over 3 hours (65%), posterior approach invasive surgery with osteosynthesis material for traumatic injury (55%) and cerebrospinal fluid fistula (5%). In relation to the evolution of the patient, obesity and coexisting infections was statistically significant (p=0.043, OR=2.00). Conclusion: Obesity or the presence of coexisting infections in the patient undergoing spinal surgery causes double the probability of exitus due to SSI.Objetivo: Determinar la incidencia de infección del sitio quirúrgico (ISQ) en los pacientes intervenidos de cirugía raquimedular y analizar los factores de riesgo intrínsecos y extrínsecos. Material y métodos: Se realizó un estudio observacional retrospectivo en el Servicio de Neurocirugía del Hospital Universitario de La Ribera (Valencia, España) que abarcó el periodo 2005-2015, donde se incluyeron los enfermos que habían sido intervenidos de cirugía de columna y que desarrollaron ISQ hasta un año después de la intervención. Resultados: De un total de 2301 cirugías vertebromedulares realizadas en 2090 pacientes, 20 presentaron ISQ en un tiempo medio de 37,7 días, lo que supone una incidencia acumulada de infección del 0,87%. Destacan factores como el tiempo quirúrgico mayor de 3 horas (65%), la cirugía invasiva vía posterior con material de osteosíntesis por lesión traumática (55%) y la fístula de líquido cefalorraquídeo (5%). En relación a la evolución del paciente, fueron variables estadísticamente significativas la obesidad y las infecciones coexistentes (p=0,043; OR=2,00). Conclusión: La obesidad o la presencia de infecciones coexistentes en el paciente sometido a cirugía raquimedular causa el doble de probabilidad de exitus por ISQ