Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution.
STUDY DESIGN
A retrospective study.


OBJECTIVES
To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery.


METHODS
This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal.


RESULTS
With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed.


CONCLUSIONS
Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.
['Wang|Muyi|M|', 'Xu|Liang|L|', 'Yang|Bo|B|https://orcid.org/0000-0003-3397-3370', 'Du|Changzhi|C|', 'Zhu|Zezhang|Z|https://orcid.org/0000-0001-8569-3595', 'Wang|Bin|B|', 'Qiu|Yong|Y|', 'Sun|Xu|X|https://orcid.org/0000-0002-7181-877X']
incidence management delayed deep surgical site infection spinal deformity implant removal progression deformity