Impact of enhanced hospital infection prevention measures during-COVID-19 pandemic on the incidence of surgical site infections following spinal instrumentation surgery for lumbar spinal stenosis: A nationwide database study

Abstract

Background context

Despite the implementation of stringent infection control measures during the COVID-19 pandemic, the impact of these interventions on surgical site infection (SSI) rates in spinal instrumentation surgery remains unclear. This study aimed to compare the incidence of SSIs after spinal instrumentation surgeries for lumbar spinal canal stenosis (LCS) before and during the COVID-19 pandemic and to assess the impact of the COVID-19 pandemic, including enhanced hospital infection prevention measures implemented during-pandemic, on the incidence of SSIs following spinal instrumented surgery for LCS.

Methods

This was a retrospective cohort study using the Diagnosis Procedure Combination database, a Japanese national database. We analyzed 42,890 patients who underwent instrumentation surgery for LCS during the prepandemic (2017–2018) and during-pandemic (2020–2021) periods. The primary outcome was the occurrence of postoperative SSIs during hospitalization. We used propensity score (PS) matching to compare SSI rates and conducted multivariate logistic regression analysis to assess the pandemic’s impact after adjusting for confounding variables

Results

Results showed a significant increase in SSI rates during-pandemic, from 1.83% to 2.53% (p<.01). After PS matching, the during-pandemic group continued to show a higher SSI rate (2.44%) compared to the prepandemic group (1.84%, p=.01). Multiple logistic regression analysis demonstrated that the association between the COVID-19 period (prepandemic versus during-pandemic) and SSI incidence remained statistically significant after adjusting for potential confounding variables (p=.01, OR=1.26).

Conclusions

These findings suggest that SSIs following instrumented spinal surgeries for LCS in Japan increased during-pandemic, even with matched patient characteristics. Future research should focus on identifying specific elements of perioperative care that may have been compromised during the pandemic and developing targeted interventions to address these gaps in surgical infection prevention.