Introduction: Surgical site infection (SSI) following spine surgery remains a serious post-operative complication with rates of infection ranging from 1% to 12%. Several patient, microbiological and procedure-related risk factors have been identified in the literature, but how these findings differ based upon race and/or socioeconomic status has not previously been explored.
Methods: A retrospective review of surgical site infection in 199 consecutive laminectomy cases performed by a single surgeon at a Level-1 trauma center in an urban setting with a majority minority patient population. Regression analysis was performed to determine the effects of race, age, sex, use of drugs, alcohol or tobacco, co-morbidities including HIV, Hepatitis C, hypertension and diabetes mellitus, and homelessness upon the likelihood of developing a SSI.
Results: Overall incidence of SSI was 19.6% with a mean of 15 days until initial presentation. 55% of the patient population was female with a mean age of 54 years. 88% of the patient population identified as Black, 7% as Caucasian, 4% as Hispanic and 1% as another race. 92% of infections occurred in Black patients, with the remaining 8% occurring in Caucasians. Positive HIV or Hepatitis C status, or homelessness were identified as significant risk factors. 85% of all HIV and 89% of all homeless patients had Medicaid insurance.
Conclusions: Incidence of SSI following laminectomy in our majority minority population is significantly higher than rates previously reported. Factors contributing to this include positive HIV or Hepatitis C status, or homelessness, which disproportionately affect minorities. Insurance status can also present challenges for post-operative rehabilitation facility placement or extended wound care. When considering mainly elective procedures such as laminectomy, the decision to operate must include a comprehensive plan that demonstrates an awareness of socioeconomic factors unique to this population that can lead to postoperative complications.
Patient Care: By providing a platform for further research, this data will allow for the development of a patient profile of those at greater risk for developing an infection following laminectomy, and the development of a post-operative antibiotic protocol with this profile in mind. The cost of hospital readmission for infection can also be calculated versus the cost of mitigating these risk factors.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify socioeconomic risk factors contributing to SSI in a majority minority population, 2) Generate ideas for how to mitigate against these risk factors