PT  - JOURNAL ARTICLE
AU  - Kreinces, Jason B.
AU  - Roof, Mackenzie A.
AU  - Friedlander, Scott
AU  - Huang, Shengnan
AU  - Bosco, Joseph A.
AU  - Fischer, Charla
TI  - The Temporality of Deep Surgical Site Infection Rates Following Spinal Laminectomy and Fusion
AID  - 10.14444/8358
DP  - 2022 Sep 16
TA  - International Journal of Spine Surgery
PG  - 8358
4099  - https://www.ijssurgery.com/content/early/2022/09/13/8358.short
4100  - https://www.ijssurgery.com/content/early/2022/09/13/8358.full
AB  - Background Deep surgical site infections (dSSI) following spinal laminectomy and fusion are serious complications associated with poor patient outcomes. The objective of this study is to investigate the monthly and seasonal variability of dSSI rates following common spinal surgeries to investigate the “July effect,” which refers to the alleged increase in adverse health outcomes due to new hospital trainees at the beginning of the academic year.Methods We performed a retrospective analysis of patients who had a dSSI following laminectomy (without fusion) or spinal fusion (with or without laminectomy) at a single large urban academic medical center between January 2009 and August 2018. The change in dSSI rate over the entire study period was calculated. The monthly and seasonal variability of dSSI were assessed using a Poisson regression model to assess for the presence of the July effect.Results A total of 7931 laminectomies and 14,637 spinal fusions were reviewed. The average dSSI rates following laminectomy and spinal fusion were 0.46 (SD, 0.47) and 1.26 (SD, 0.86) per 100 patients, respectively. The rate of dSSI following spinal fusion significantly decreased over the study period (rate ratio [RR] = 0.89, 95% CI 0.84–0.94, P < 0.01). With summer as the reference season, there were significantly lower dSSI rates following spinal fusions performed in the fall (RR = 0.62, 95% CI 0.39–0.98, P = 0.04 ). With July as the reference month, there was a significantly higher dSSI rate in April following spinal fusions.Conclusion The overall decrease in dSSI rate over the study period is consistent with previous reports. The monthly analysis revealed no significant differences in either procedure, calling into question the July effect.Clinical Relevance This study is relevant to practicing spinal surgeons and can inform surgeons about seasonal data regarding dSSIs.Level of Evidence 3.