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01-10-2018 | Original Article

What are the risk factors for surgical site infection after spinal fusion? A meta-analysis

Authors: Sebastien Pesenti, Tejbir Pannu, Jessica Andres-Bergos, Renaud Lafage, Justin S. Smith, Steve Glassman, Marinus de Kleuver, Ferran Pellise, Frank Schwab, Virginie Lafage, on behalf of the Scoliosis Research Society (SRS)

Published in: European Spine Journal | Issue 10/2018

Abstract

Purpose

Although many risk factors for surgical site infection (SSI) following spinal fusion have been described in the literature, methodologies and study cohorts vary widely. Patient- and procedure-specific risk factors for (SSI) can be identified via a meta-analysis. We sought to review the existing data and isolate significant risk factors for SSI in patients undergoing thoracolumbar spinal fusion.

Methods

The literature was searched through December of 2016. Studies including adult patients undergoing thoracolumbar spinal fusion surgery (single or multilevel, anterior, posterior or combined approach) were identified. Only studies that included an odds ratio (OR) for SSI or sufficient data to calculate it were included. A meta-analysis was performed using RevMan 5.1. Depending on heterogeneity (I²), OR with 95% confidence intervals was calculated using either the fixed-effects model (when I² < 60%) or the random-effects model (when I² > 60%).

Results

6482 manuscripts were identified and reviewed. 29 manuscripts with 374,488 patients met the criteria for inclusion. Twelve risk factors were assessed by the meta-analysis and grouped into two categories (patient related and procedure related). Significant patient-related factors for SSI included obesity, diabetes, ASA score, tobacco use and revision status. Procedure-related risk factors included operative time, use of osteotomy, fusion length and extension of fusion to the sacrum or pelvis.

Conclusions

This meta-analysis identified significant risk factors for SSI following spine arthrodesis. These included potentially modifiable factors such as obesity, diabetes, smoking status and procedure-related parameters. Non-modifiable risk factors were identified, including ASA score and age. These factors may prove useful for patient counseling as well as surgical planning.

Level of evidence

Level III (Meta-analysis including studies with a level of evidence of III or higher).

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Title: What are the risk factors for surgical site infection after spinal fusion? A meta-analysis
Authors: Sebastien Pesenti
Tejbir Pannu
Jessica Andres-Bergos
Renaud Lafage
Justin S. Smith
Steve Glassman
Marinus de Kleuver
Ferran Pellise
Frank Schwab
Virginie Lafage
on behalf of the Scoliosis Research Society (SRS)
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 10/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5733-7

At a glance: The STEP trials

Springer Medicine

What are the risk factors for surgical site infection after spinal fusion? A meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Graphical abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Graphical abstract

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