Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients

Abstract

Background: Patients requiring posterior lumbar surgery have increased annually. Incision infection after lumbar surgery has serious consequences for patients. However, data on the related factors of incision infection after lumbar surgery in diabetic patients are limited. Therefore, this study aimed to analyze diabetic patients who underwent lumbar surgery and to explore the risk factors of perioperative incision infection to provide a scientific basis for perioperative intervention of lumbar spine surgery and reduce risk of incision infection in such patients. Methods: We retrospectively reviewed data of diabetic patients who underwent posterior lumbar surgery from 2011 to 2016. A total of 523 diabetic patients undergoing posterior lumbar surgery were analyzed for the influence of various risk factors on postoperative incision infection. Univariate and multivariate logistic regression was performed. The test level was α=.05, and P < .05 was considered statistically significant. Results: In the past 6 years, among the 523 diabetic patients, the incidence of incision infection after posterior lumbar surgery was approximately 7.1%, of which the shallow incision infection rate was 4.2% and the deep incision infection rate was 2.9%. Incision infection of posterior lumbar surgery in diabetic patients is related to smoking, preoperative glycosylated hemoglobin A1c, postoperative albumin (Alb), surgical segment, operation time, and intraoperative blood loss, especially on postoperative fasting blood glucose, postoperative postprandial blood glucose, local subcutaneous fat thickness, and operation sequence (odds ratio >5.00). Meanwhile, sex, age, body mass index (BMI), preoperative Alb, and newly diagnosed diabetes were not highly correlated with incision infection after posterior lumbar surgery. Conclusion: Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery.

Smoking increases the risk of infectious diseases: A narrative review

“…For patients with diabetes, smoking is a risk factor of postoperative infection. Peng et al 182 proved that smoking is a risk factor for wound infection after lumbar surgery in patients with diabetes (OR=3.830; 95% CI: 1.003-6.684); however, 4 weeks of strict smoking cessation prior to surgery reduced the risk of wound infection. Smoking results in an increased risk of infection at other sites after surgery with a prolonged hospitalization time and increased expenses.…”

Association of Preoperative Hemoglobin A1c and Body Mass Index with Wound Infection Rate in Spinal Surgery

“…A more recent study 18 examined a cohort of 523 diabetic patients who underwent posterior lumbar surgery with a wound infection rate of 7.1%. They found that HbA1c 7.50 increased the odds of a wound infection significantly, but did not find a correlation between age or BMI and wound infection risk.…”

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

“…Hwang, J. U. team discovered that hb1c level more than 6.9% would increase the risk of getting SSI [29]. Peng, W. concluded that during 6 years of retrospective study of 523 Diabetes Mellitus patient who went for lumbar surgery, 7.1% got SSI, superficial infection accounted for 4.2% and deep infection made up 2.9% [30]. So preoperative blood glucose level, hb1c level control is strictly required for prevention SSI.…”

“…Risk factor correlated with SSI. Correlation of the surgical duration with SSI(Kim et al, 2014) 30. days after an operative procedure and involves deep soft tissues of the incision fascial and muscle layers[10].Early diagnosis of surgical site infection can improve the prognosis.…”