Infectious Complications of Stereotactic Navigation in Posterior or Posterolateral Thoracic and Lumbar Spinal Fusion and Posterior Lumbar Interbody Fusion for Degenerative Spinal Disease: An ACS-NSQIP Study.

Abstract

Background context: Intraoperative stereotactic navigation systems are routinely used in thoracic and lumbar spine surgery to enhance precision and improve visualization of relevant anatomy. However, the potential impact of navigation on postoperative infection remains controversial.

Purpose: This study aims to evaluate the association between stereotactic navigation and postoperative infection following posterior or posterolateral thoracic fusion (PTF), posterior or posterolateral lumbar fusion (PLF), and posterior lumbar interbody fusion (PLIF) for degenerative pathology.

Study design: Retrospective Cohort PATIENT SAMPLE: National Surgical Quality Improvement Program (NSQIP) Database OUTCOME MEASURES: Primary outcomes included database-reported thirty-day reoperation rates, readmission rates, mortality, superficial surgical site infection (SSI), deep SSI, sepsis, septic shock, and wound dehiscence.

Methods: We conducted a retrospective analysis of the NSQIP database to investigate patients who received PTF, PLF, or PLIF for degenerative pathology from 2015 to 2020. Patients were divided into two cohorts: those who underwent surgery with stereotactic navigation and those without. Baseline demographics and comorbidities including patient sex, patient age, body mass index (BMI), diabetes mellitus, smoking status, chronic obstructive pulmonary disease, ventilator dependency, congestive heart failure, hypertension, acute renal failure, dialysis status, disseminated cancer, steroid use, and previous wound infection as well as operative time and length of stay (LOS) were collected. Chi-square tests and logistic regression analysis were conducted for univariate and multivariate analysis, respectively, of baseline demographics and primary outcomes.

Results: A total of 7,537 patients who received PTF, PLF, or PLIF with stereotactic navigation were identified and compared to 108,033 patients who received these operations without navigation. Mean operative time (235.5 ± 102.4 min vs 181.5 ± 99.9 min, p<0.001) and LOS (3.9 ± 5.1 days vs 2.9 ± 4.8 days, p<0.001) were significantly longer for the navigation cohort than for the non-navigation cohort. Controlling for patient age, LOS, operative time, previous open wound infection, steroid use, smoking status, diabetes mellitus, revision status, and frailty, navigation-assisted PTF, PLF, or PLIF was associated with significantly higher odds of superficial surgical site infection (p=0.046) and all postoperative infection (p=0.045) within 30 days of index procedure.

Conclusions: The use of stereotactic navigation systems in posterior or posterolateral thoracic and lumbar fusion or posterior lumbar interbody fusion procedures is associated with increased odds of postoperative infection. These findings highlight the complex relationship between navigation and surgical outcomes, creating a cost versus benefit decision model and demonstrating the need for further research to optimize use and improve patient safety.