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

Figures & data

Figure 1 Eligibility of studies for inclusion in meta-analysis.

Table 1 Baseline characteristics of patients in trials included

Study	Country	Design	SSI group	Non-SSI group	Surgery	NOS s core
Lim et al^Citation28	USA	Retrospective case–control	173	3,180	Single-level lumbar fusion surgery	7
Kim et al^Citation29	South Korea	Retrospective case–control	30	1,801	Posterior lumbar interbody fusion	7
Habiba et al^Citation30	Norway	Retrospective case–control	40	1,732	Lumbar disc herniation without laminectomy or fusion	7
Koutsoumbelis et al^Citation31	USA	Retrospective case–control	84	168	Posterior lumbar instrumented arthrodesis	5
Lee et al^Citation32	USA	Retrospective case–control	15	134	Lumbar spine surgery	5
Liu et al^Citation33	China	Retrospective case–control	64	192	Posterior lumbar spinal surgery	6
Ogihara et al^Citation34	Japan	Prospective cohort study	24	2,712	Posterior lumbar spinal surgery	7
Chaichana et al^Citation35	USA	Retrospective case–control	37	780	Posterior instrumented lumbar fusion	5
Mehta et al^Citation36	USA	Retrospective case–control	24	274	Lumbar spinal fusion	7
Petilon et al^Citation37	USA	Propensity score-matched case–control study	30	30	Instrumented lumbar spinal fusion	6
Falavigna et al^Citation38	Brazil	Prospective cohort study	13	39	Lumbar arthrodesis	7
Schimmel et al^Citation39	the Netherlands	Retrospective case–control	36	135	Lumbar spinal fusion	5
Chen et al^Citation40	USA	Retrospective case–control	30	165	Lumbar spinal fusion	6
Blam et al^Citation41	USA	Retrospective cohort	24	232	Lumbar spinal fusion	7
Lai et al^Citation42	China	Retrospective case–control	26	897	Lumbar spine surgery	6
Haleem et al^Citation43	USA	Retrospective case–control	54	218	Lumbar spine surgery	6

Abbreviations: NOS, Newcastle–Ottawa Scale; SSI, surgical site infection.

Figure 2 Forest plot showing the relationship between male sex and postoperative surgical site infection.

Table 2 Pooled estimates of RR (WMD)a obtained from meta-analysis of risk factors of SSI following lumbar spine surgery

	RR	95% CI	P-value
Male sex	0.88	0.80–0.97	0.008
Diabetes	2.19	1.43–3.36	<0.001
Current smoking	0.89	0.75–1.06	0.178
ASA grade >II	2.63	0.84–8.27	0.098
Obesity	2.87	1.62–5.09	<0.001
Increased agea	1.43	−1.15 to 4.02	0.2777
BMIa	1.32	0.39–2.25	0.006
Duration of surgerya	24.96	14.77–35.15	<0.001
Duration of hospital staya	2.07	0.28–3.87	0.024
Estimated blood lossa	106.90	−65.14 to 278.53	0.224
COPD	1.21	0.68–2.17	0.521
Hypertension	1.28	1.08–1.52	0.005
Cardiovascular disease	1.63	0.40–6.70	0.495
Rheumatoid arthritis	1.76	0.53–5.90	0.359
Osteoporosis	1.91	0.79–4.63	0.152
Allogeneic blood transfusion	1.39	0.59–3.27	0.457
Previous surgery	2.06	1.39–3.06	<0.001
Implanted instrument	1.41	1.19–1.66	0.533
Sleep apnea	1.00	0.18–5.35	1.00
Hypercholesterolemia	1.07	0.70–1.62	0.764

Note:

a Results expressed as WMD with 95% CI.

Abbreviations: WMD, weighted mean difference; SSI, surgical site infection; ASA, American Society of Anesthesiologists; BMI, body-mass index.

Figure 3 Forest plot showing relationship between increased age and postoperative surgical site infection.

Note: Weights are from random-effects analysis.

Figure 4 Forest plot showing the relationship between diabetes and postoperative surgical site infection.

Note: Weights are from random-effects analysis.

Figure 5 Forest plot showing the relationship between current smoking and postoperative surgical site infection.

LimSEdelsteinAIPatelAAKimBDKimJYSJysKRisk Factors for Postoperative Infections After Single-Level Lumbar Fusion SurgerySpine201843321522225271498

 PubMed Web of Science ®Google Scholar

KimJHAhnDKKimJWKimGWParticular Features of Surgical Site Infection in Posterior Lumbar Interbody FusionClin Orthop Surg20157333734326330956

 PubMedGoogle Scholar

HabibaSNygaardØPBroxJIHellumCAustevollIMSolbergTKRisk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based studyActa Neurochir201715961113111828424918

 PubMed Web of Science ®Google Scholar

KoutsoumbelisSHughesAPGirardiFPRisk factors for postoperative infection following posterior lumbar instrumented arthrodesisJ Bone Joint Surg Am201193171627163321915578

 PubMed Web of Science ®Google Scholar

LeeJJOdehKIHolcombeSAFat Thickness as a Risk Factor for Infection in Lumbar Spine SurgeryOrthopedics2016396e1124e112827575036

 PubMed Web of Science ®Google Scholar

LiuJMDengHLChenXYRisk Factors for Surgical Site Infection After Posterior Lumbar Spinal SurgerySpine2018431073273728922276

 PubMed Web of Science ®Google Scholar

OgiharaSYamazakiTMaruyamaTProspective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adultsJ Orthop Sci2015201717725366698

 PubMed Web of Science ®Google Scholar

ChaichanaKLBydonMSantiago-DieppaDRRisk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive casesJ Neurosurg Spine2014201455224206038

 PubMed Web of Science ®Google Scholar

MehtaAIBabuRKarikariIO2012 Young Investigator Award winner: The distribution of body mass as a significant risk factor for lumbar spinal fusion postoperative infectionsSpine201237191652165622146285

 PubMed Web of Science ®Google Scholar

PetilonJMGlassmanSDDimarJRCarreonLYClinical outcomes after lumbar fusion complicated by deep wound infection: a case–control studySpine201237161370137422261633

 PubMed Web of Science ®Google Scholar

FalavignaARighessoOTraynelisVCTelesARda SilvaPGEffect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study: clinical articleJ Neurosurg Spine201115439940321682558

 PubMed Web of Science ®Google Scholar

SchimmelJJHorstingPPde KleuverMWondersGvan LimbeekJRisk factors for deep surgical site infections after spinal fusionEur Spine J201019101711171920445999

 PubMed Web of Science ®Google Scholar

ChenSAndersonMVChengWKWongworawatMDDiabetes associated with increased surgical site infections in spinal arthrodesisClin Orthop Relat Res200946771670167319225851

 PubMed Web of Science ®Google Scholar

BlamOGVaccaroARVanichkachornJSRisk factors for surgical site infection in the patient with spinal injurySpine200328131475148012838110

 PubMed Web of Science ®Google Scholar

LaiQSongQGuoRRisk factors for acute surgical site infections after lumbar surgery: a retrospective studyJ Orthop Surg Res201712111628724387

 PubMed Web of Science ®Google Scholar

HaleemAChiangHYVodelaRRisk Factors for Surgical Site Infections Following Adult Spine OperationsInfect Control Hosp Epidemiol201637121458146727573067

 PubMed Web of Science ®Google Scholar