Risk factors for acute surgical site infections after lumbar surgery: a retrospective study

Abstract

BackgroundCurrently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery.MethodsWe retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital’s spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses.ResultsTwenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients’ mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p < 0.05). Additionally, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, preoperative antibiotics, type of disease, and operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p < 0.05). Using binary logistic regression analyses, body mass index, smoking, diabetes mellitus, osteoporosis, preoperative antibiotics, fracture, operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery.ConclusionsIn order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-017-0612-1) contains supplementary material, which is available to authorized users.

Risk factors for surgical site infection following lumbar spinal surgery: a meta-analysis

“…Four studies investigated the relationship between estimated blood loss and postoperative SSI. 33 , 37 , 41 , 42 The pooled result showed that patients with greater blood loss had a higher risk of SSI (WMD 106.9 mL, 95% CI 65.14–278.53); however, this was not significant ( P =0.224). This indicated that increased blood loss was not a significant risk factor for SSI in patients who had undergone lumbar spine surgery.…”

“…Five studies investigated the relationship between COPD and postoperative SSI. 28 , 31 , 39 , 42 , 43 Pooled estimates suggested that patients with COPD had a similar rate of SSI as those without (RR 1.21, 95% CI 0.68–2.17; P =0.521). This indicated that COPD was not a significant risk factor for SSI in patients who had undergone lumbar spine surgery.…”

“…The total sample size was 13,393, of which 704 were in the SSI group and 12,689 the non-SSI group. Among these studies, nine 28 , 31 , 32 , 35 – 37 , 40 , 41 , 43 were conducted in the US, two in China, 33 , 42 and one each in South Korea, 29 Norway, 30 Japan, 34 Brazil, 38 and the Netherlands. 39 Most studies were performed with a retrospective case–control design, except three, which were prospective 34 , 38 or retrospective 41 cohort design.…”

“…Twelve studies investigated the relationship between diabetes and postoperative SSI. 28 , 29 , 31 – 36 , 39 , 40 , 42 , 43 The pooled estimate suggested that diabetes patients had a 2.19-fold increased risk of developing SSI compared with those without diabetes (RR 2.19, 95% CI 1.43–3.36; P <0.00; Figure 4 ). Heterogeneity was significant ( I 2 =90.1%, P <0.001), and thus we conducted sensitivity analysis.…”

A prediction model of surgical site infection after instrumented thoracolumbar spine surgery in adults

“…In the previous literature, patients with comorbid medical conditions were found to be significantly associated with SSI [7,28,29]. Trauma, adult spinal deformity with long segment procedures, spondylodiscitis and malignancy had a higher risk for SSI than degenerative or failed back surgery syndrome [6,[30][31][32][33]. Also older age had an increased risk of postoperative spinal infection [13,34].…”