New Scoring System to Predict Need for Multiple Surgeries for Spinal Infection
Six reliable factors have been identified as the most accurate predictors of the need for multiple "clean up" surgeries for surgical site infections following spine surgery. By "clean up" surgery, we mean the procedure called irrigation and debridement, a way to remove infection and cleanse the wound.
Surgical site infections after spinal surgery are not uncommon. Irrigation and debridement is the usual first-line of treatment for the problem. In one-fourth up to one-half of all patients with spinal surgical site infections, more than one clean-up procedure is required.
If the surgeon had some way to predict which patients might be at increased risk for this complication, then measures could be taken to reduce the risk. In this article, surgeons from the University of Massachusetts Medical Center present a model they developed to determine the need for a single irrigation and debridement versus multiple procedures.
This scoring system is called the Postoperative Infection Treatment Score for the Spine or PITSS. The surgeons developed the model and tested it on a large group of patients at one spine center. Once the scoring system was determined to be reliable, they validated it by repeating the study on a separate group of patients.
The predictive is based on the presence of one or more of six predictive factors: 1) location of infection in the spine, 2) patient's health (presence of other diseases like diabetes, pneumonia, or heart disease), 3) type of infection, 4) presence of infection elsewhere in the body, 5) use of hardware in the spine such as metal plates and screws, and 6) the need for bone graft for the initial spinal surgery.
Over 30 factors were tested for significance and ability to predict the need for multiple debridement procedures. Patients with one or more of these six factors were the most likely to need more than a single debridement procedure. Once the test was applied to the patient and a high risk was determined, then additional care could be provided early on. This early intervention may reduce costs, duration of hospital stay, and need for further surgeries.
The authors stand by their new scoring system as being effective and reliable. But they do say that surgeons must use this as a tool along with their own judgment for each patient. The PITSS provides an aid in predicting which patients with a surgical site infection after spinal surgery may need multiple irrigation and debridement procedures. Setting up surgical dates in advance and preparing for the possibility of a second (or third) debridement procedure will benefit the patient in recovering more quickly from these infections with lower costs.
Christian P. DiPaola, MD, et al. Postoperative Infection Treatment Score for the Spine (PITSS): Construction and Validation of a Predictive Model to Define Need for Single Versus Multiple Irrigation and Debridement for Spinal Surgical Site Infection. In Spine Journal. March 2012. Vol. 12. No. 3. Pp. 218-230.