Medical Student Montefiore Medical Center/Albert Einstein College of Medicine Bronx, New York, United States
Introduction: Postoperative surgical site infection (SSI) is a serious complication seen in spinal intervention, which can result in severe morbidity and increased care-related costs. Several intraoperative risk factors for SSI have been previously described, including surgical attire, procedure type, and operative duration. However, few studies have evaluated the effect of operating room size, with even fewer studies focusing on the spine population. The purpose of this study was to determine if operating room size has an independent effect on 30-day postoperative SSI incidence amongst patients undergoing spinal surgery.
Methods: This was a single institution retrospective cohort study consisting of 728 consecutive adult patients who underwent any spinal surgery between January 1, 2021 and August 31, 2022. Electronic medical records were reviewed to obtain demographics, medical comorbidities, and operative details. Our primary outcome was any new SSI within 30 days following surgery. Operating room areas were obtained from engineering blueprints, where large rooms were defined as greater than 550 ft2 and small rooms were defined as less than 550 ft2. Statistical analyses were done using univariable and multivariable logistic regression.
Results: All surgeries took place in one of six operating rooms, where 46% of patients were in a large room. The total 30-day SSI incidence was 6.7%, of which 24.5% of SSIs occurred in large rooms and 75.5% occurred in small rooms. In univariable logistic regression, large room size was found to be associated with decreased odds of postoperative SSI (odds ratio [OR] 0.36; 95% confidence interval [CI] 0.18-0.69; p=0.002). After controlling for confounders including American Society of Anesthesiologists (ASA) classification, coronary artery disease, peripheral vascular disease, emergency surgery, and operative duration, large room size was found to be independently associated with decreased SSI (OR 0.39; 95% CI 0.19-0.79; p=0.008).
Conclusion : In this study, large operating room size greater than 550 ft2 was found to be independently associated with decreased odds of 30-day postoperative SSI in adults undergoing spinal surgery. Although prospective studies are needed to validate these findings, our results may aid in establishing operating room standards with the goal of reducing modifiable risk factors for wound infections.
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