Electronic Medical Records Of Four Senior Surgeons For All...

Abstract Introduction Intra-operative cultures may be obtained in revision spine surgery despite the absence of pre-operative clinical markers of infection (wound drainage, fevers, elevated ESR/CRP/WBC, etc). The microbiologic profile of culture positive cases in which there is no clear evidence of infection preoperatively has not been described. The aim of this investigation is to report on the microbiologic profile of this unique patient population. Methods We retrospectively reviewed the electronic medical records of four senior surgeons for all revision spine surgery cases performed between 2008-2013. During the study period, 595 revision surgeries were performed. Seventeen cases were performed for the primary diagnosis of†¦show more content†¦Pseudarthrosis was the most common diagnosis overall (49.1%) in which intra-operative cultures were obtained, followed by recurrent index disease (17.0%). Pseudarthrosis was also the most common revision surgical diagnosis where cultures were positive (55.6%). Including all patients who had revision surgery for the diagnosis of pseudoarthrosis (both cultured and not cultured), 18.9%(24/127) had positive cultures. When pseudarthrosis was the primary diagnosis at revision surgery and cultures were taken, Propionobacterium acnes was cultured in 54.2% of cases; though, this was not stastistically more common than other organisms (p = 0.6381). Overall, staphylococcal species were found most commonly (57.8% of cases), but Propionobacterium acnes was at least one of the isolates in 48.9% of cases and was the most common organism isolated. Polymicrobial cultures were obtained in 22.2% of cases. MRSA infections were found in only 6.7% of cases. Non-instrumented cases were significantly more likely to develop an infection (p = 0.0253) than instrumented cases. Positive cultures were seen more commonly in non-fusion cases than fusion cases (p = 0.027). Those fused to the sacrum were less likely to have positive cultures than those who did not have fusion to the sacrum (p = 0.032). Conclusions Intra-operative cultures are commonly obtained in the setting of revision spine surgery without overwhelming clinical evidence for infection. The