Is It Cost Effective to Obtain Fungal and Acid-Fast Bacillus Cultures during Spine Debridement?

Retrospective study. To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal perf...

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Published inAsian spine journal Vol. 16; no. 4; pp. 519 - 525
Main Authors Lambrechts, Mark J, Clair, Devin D St, Li, Jinpu, Cook, James L, Spence, Bradley S, Leary, Emily V, Choma, Theodore J, Moore, Donald K, Goldstein, Christina L
Format Journal Article
LanguageEnglish
Published Korea (South) Korean Society of Spine Surgery 01.08.2022
Korean Spine Society
대한척추외과학회
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Abstract Retrospective study. To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective. Spine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking. A retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed. For patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33-23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment. Spine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB.
AbstractList Study Design Retrospective study. Purpose To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective. Overview of Literature Spine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking. Methods A retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed. Results For patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33–23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment. Conclusions Spine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB.
STUDY DESIGNRetrospective study. PURPOSETo identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective. OVERVIEW OF LITERATURESpine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking. METHODSA retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed. RESULTSFor patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33-23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment. CONCLUSIONSSpine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB.
Study Design: Retrospective study.Purpose: To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective.Overview of Literature: Spine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking.Methods: A retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed.Results: For patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33–23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment.Conclusions: Spine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB. KCI Citation Count: 0
Retrospective study. To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections are more common in certain spine segments, identify comorbidities associated with these infections, and determine whether the universal performance of fungal and AFB cultures during spine debridement is cost effective. Spine infections are associated with significant morbidity and costs. Spine fungal and AFB infections are rare, but their incidence has not been well documented. As such, guidance regarding sample procurement for AFB and fungal cultures is lacking. A retrospective review of medical record data from patients undergoing spine irrigation and debridement (I&D) at the University of Missouri over a 10-year period was performed. For patients undergoing spine I&D, there was a 4% incidence of fungal infection and 0.49% rate of AFB infection. Steroid use was associated with a higher likelihood (odds ratio, 5.62; 95% confidence interval, 1.33-23.75) of positive fungal or AFB cultures. Although not significant, patients undergoing multiple I&D procedures had higher rates of positive fungal cultures during each subsequent I&D. Over a 10-year period, if fungal cultures are obtained for each patient, it would cost our healthcare system $12,151.58. This is compared to an average cost of $177,297.64 per missed fungal infection requiring subsequent treatment. Spine fungal infections occur infrequently at a rate of 4%. Physicians should strongly consider obtaining samples for fungal cultures in patients undergoing spine I&D, especially those using steroids and those undergoing multiple I&Ds. Our AFB culture rates mirror the false positive rates seen in previous orthopedic literature. It is unlikely to be cost effective to send for AFB cultures in areas with low endemic rates of AFB.
Author Goldstein, Christina L
Lambrechts, Mark J
Spence, Bradley S
Leary, Emily V
Clair, Devin D St
Moore, Donald K
Cook, James L
Choma, Theodore J
Li, Jinpu
AuthorAffiliation 2 Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
1 Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
3 Department of Orthopaedic Spine Surgery, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
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10.1503/cmaj.190178
10.1016/j.jocn.2015.03.065
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Issue 4
Keywords Cost-benefit analysis
Fungi
Lumbar spine
Cost-savings
Antifungal agents
Bacillus
Surgical wound infection
Language English
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PublicationTitle Asian spine journal
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대한척추외과학회
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Snippet Retrospective study. To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine whether these infections...
Study Design: Retrospective study.Purpose: To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine...
Study Design Retrospective study. Purpose To identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine...
STUDY DESIGNRetrospective study. PURPOSETo identify the rate of positive acid-fast bacillus (AFB) and fungal cultures during spine debridement, determine...
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SubjectTerms Age
antifungal agents
bacillus
Back surgery
Bacterial infections
Chronic obstructive pulmonary disease
Clinical Study
Comorbidity
Cost analysis
Cost control
cost-benefit analysis
cost-savings
Debridement
Diabetes
Fungal infections
fungi
Health care policy
Hospital costs
lumbar spine
Medicare
Morbidity
Patients
Reimbursement
Risk factors
Steroid hormones
surgical wound infection
정형외과학
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Title Is It Cost Effective to Obtain Fungal and Acid-Fast Bacillus Cultures during Spine Debridement?
URI https://www.ncbi.nlm.nih.gov/pubmed/34784701
https://www.proquest.com/docview/2712894590
https://search.proquest.com/docview/2598541565
https://pubmed.ncbi.nlm.nih.gov/PMC9441443
https://doaj.org/article/00dd4fe091914334bf95d0a0c0b40be4
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Volume 16
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ispartofPNX Asian Spine Journal, 2022, 16(4), , pp.519-525
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