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A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery

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Abstract

Objective

To identify the independent risk factors, based on available evidence in the literature, for patients developing surgical site infections (SSI) after spinal surgery.

Methods

Non-interventional studies evaluating the independent risk factors for patients developing SSI following spinal surgery were searched in Medline, Embase, Sciencedirect and OVID. The quality of the included studies was assessed by a modified quality assessment tool that had been previously designed for observational studies. The effects of studies were combined with the study quality score using a best-evidence synthesis model.

Results

Thirty-six observational studies involving 2,439 patients with SSI after spinal surgery were identified. The included studies covered a wide range of indications and surgical procedures. These articles were published between 1998 and 2012. According to the quality assessment criteria for included studies, 15 studies were deemed to be high-quality studies, 5 were moderate-quality studies, and 16 were low-quality studies. A total of 46 independent factors were evaluated for risk of SSI. There was strong evidence for six factors, including obesity/BMI, longer operation times, diabetes, smoking, history of previous SSI and type of surgical procedure. We also identified 8 moderate-evidence, 31 limited-evidence and 1 conflicting-evidence factors.

Conclusion

Although there is no conclusive evidence for why postoperative SSI occurs, these data provide evidence to guide clinicians in admitting patients who will have spinal operations and to choose an optimal prophylactic strategy. Further research is still required to evaluate the effects of these above risk factors.

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Acknowledgments

The authors thank Professor Edmund Y.S. Chao and Jun Lu for their advice on researching the unpublished literature. This study was supported by grants from the National Natural Science Foundation of China (No. 81102607), the Key Technologies & Program of Tianjin (No. 11ZCGYSY01800) and the Scientific and Technological Project of Tianjin Public Health Bureau (No. 11KG137).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052, China

    Dan Xing, Jian-Xiong Ma, Xin-Long Ma, Jie Wang & Rui Feng

  2. Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211, China

    Xin-Long Ma, Yang Chen, Yang Yang, Shao-Wen Zhu & Bao-Yi Ma

  3. Department of Orthopaedics, Tianjin Gongan Hospital, 78 Nanjing Street, Heping District, Tianjin, 300042, China

    Dan Xing & Dong-Hui Song

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  1. Dan Xing
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Correspondence to Xin-Long Ma or Dong-Hui Song.

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D. Xing and J.-X. Ma contributed equally to this work.

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Xing, D., Ma, JX., Ma, XL. et al. A methodological, systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery. Eur Spine J 22, 605–615 (2013). https://doi.org/10.1007/s00586-012-2514-6

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  • DOI: https://doi.org/10.1007/s00586-012-2514-6

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