Clinical burden and treatment pathways of early deep surgical site infection after lumbar spine surgery: a Vietnamese single-center descriptive study.

BACKGROUND

Early deep surgical site infection (SSI) after lumbar spine surgery is uncommon, but management may require repeated surgery, negative-pressure wound therapy, prolonged antimicrobial treatment, and complex implant-related decisions. We aimed to characterize the clinical course, treatment pathways, and major treatment-burden events among affected patients.

METHODS

This retrospective descriptive study screened 1,923 patients who underwent primary lumbar spine surgery at a single tertiary center between October 2018 and October 2023. Sixteen patients met an operational definition adapted from Centers for Disease Control and Prevention/National Healthcare Safety Network criteria for early deep incisional or organ/space SSI within 90 days. Analyses were descriptive; an exploratory comparison of cumulative infection-related inpatient days was summarized without predictive inference.

RESULTS

Sixteen early deep SSIs were identified [crude institutional incidence, 0.83%; 95% confidence interval (CI), 0.48-1.35%]. Diagnosis occurred a median of 14.5 days after surgery [interquartile range (IQR), 6.8-20.8; range, 4-70]. Fourteen patients underwent 52 spinal reoperations; 10 required vacuum-assisted closure with 37 foam changes. Two required intensive care, two were readmitted, and no deaths occurred. Cultures yielded methicillin-susceptible Staphylococcus aureus (n=6), methicillin-resistant S. aureus (n=2), Escherichia coli (n=3), Enterococcus faecium (n=1), and Enterobacter cloacae (n=1); one culture was negative and two patients were not cultured. Eight patients experienced a major treatment-burden event: infection-related adverse outcomes (n=4), an unplanned small-bowel injury during revision (n=1), or implant-removal source-control procedures (n=3). Median cumulative infection-related inpatient duration was 46.5 days with an event and 23.0 days without an event.

CONCLUSIONS

Early deep SSI was uncommon in this single-center series but imposed considerable procedural and inpatient burden among affected patients. The findings support early recognition, microbiological confirmation when feasible, careful revision planning, and coordinated multidisciplinary infection management, while avoiding causal or predictive conclusions from this small descriptive cohort.