Surgical Site Infections in Posterior Lumbar Surgery
Bibliographic record
Abstract
STUDY DESIGN: A retrospective, single-center cohort study of consecutive patients undergoing posterior lumbar decompression between 2007 and 2013 was conducted. OBJECTIVE: To compare rates of surgical site infection between matched cohorts of patients undergoing lumbar surgery with and without intraoperative application of epidural steroid pastes. SUMMARY OF BACKGROUND DATA: Epidural steroid agents reduce postoperative pain and inflammation following lumbar surgery, reducing the use of postoperative narcotics and improving McGill pain scores. Preliminary studies have, however, suggested an increase in surgical site infections following the use of these steroid-containing pastes. METHODS: We reviewed 758 patients undergoing decompression performed at a single center by surgeons who either routinely used or never used an analgesic steroid paste. Patients undergoing instrumentation or revision surgery were excluded, and surgical and postoperative protocols were uniform. Two hundred eighty-three patients met specific inclusion and exclusion criteria. Demographic, clinical, and surgical data were assessed and correlated to the incidence of postoperative infections. Multivariate logistic regression controlled for confounding characteristics and identified independent predictors of postoperative surgical-site infections. RESULTS: Patient demographics, comorbidities, and perioperative protocols were similar between groups. There were six acute infections among 103 patients receiving steroid paste (5.83%), and two infections among 180 patients not receiving paste (1.11%), a statistically significant difference which remained after controlling for confounding characteristics (odds ratio 6.74, P = 0.01). All but one infection occurred among patients with identifiable preoperative risk factors for infection. CONCLUSION: The observed increase in infection among patients receiving pain paste is clinically significant, but infection was primarily observed among at-risk patients. The present study confirms suspicions raised in preliminary studies, and we recommend caution when treating patients with identifiable, comorbid risk factors. LEVEL OF EVIDENCE: 3.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".