Analysis of risk factors for early surgical site infection after lumbar spinal surgery in elderly patients

doi:10.21203/rs.3.rs-2972208/v1

Download PDF

Research Article

Analysis of risk factors for early surgical site infection after lumbar spinal surgery in elderly patients

https://doi.org/10.21203/rs.3.rs-2972208/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

To explore the risk factors of early surgical site infection (SSI) after posterior lumbar interbody fusion in elderly patients with lumbar degenerative diseases.

Methods

A retrospective study was carried out. The elderly patients who underwent posterior lumbar interbody fusion for degenerative diseases of lumbar spine from January 2019 to December 2021 were included in this study. 18 patients with early postoperative SSI were included into the infection group, and 54 patients without SSI were randomly selected as the control group by the ratio of 1:3 during the same period according to age, gender and diagnosis. First, univariate analysis was performed on the general data, perioperative data and laboratory indexes in both groups. Then, indexes that were statistically significant in univariate analysis and closely related to SSI were incorporated into multiple Logistic regression to determine the risk factors associated with postoperative SSI. Finally, Receiver operating characteristic (ROC) curve analysis was conducted for quantitative variables belonging to risk factors.

Results

Univariate analysis showed that there were significant differences in surgical duration, preoperative lymphocyte count, postoperative neutrophil count, neutrophil percentage, lymphocyte count, lymphocyte percentage, the neutrophil/lymphocyte count ratio (NLR) and serum albumin concentration between the infected and non-infected groups (P < 0.05). Multiple logistic regression analysis showed that diabetes, surgical duration, and postoperative neutrophil percentage were risk factors for SSI in elderly patients with lumbar degenerative disease undergoing posterior interbody fusion and internal fixation (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of surgical duration was 0.680, and the cut-off value was 177.5min. AUC of postoperative neutrophil percentage was 0.841 and the cut-off value was 78.85%.

Conclusions

For elderly patients who underwent posterior lumbar interbody fusion, we need to pay more attention to diabetes mellitus, longer surgical duration and postoperative percentage of neutrophis, which are more likely to be associated with increased early SSI.

Lumbar degenerative disease

posterior lumbar interbody fusion

surgical site infection

risk factors

Posterior lumbar interbody fusion is a routine and effective operation for elderly patients with degenerative disease; however, complications occur in some paitents after operation. Surgical site infection (SSI) is one of the serious complications which can prolong hospital stays, create long-term disability, increase resistance to life-saving medications, drive up costs for patients and their family, and even lead to death. In spite of every precaution, the infection rate reached 0.7%-12% [1, 2, 3]. As the population ages, more and more older people are undergoing lumbar interbody fusion surgery. Compared with young patients, the elderly have more underlying diseases, poor physique, poor nutritional status and decreased immunity to disease. If SSI occurs, its harm degree and treatment difficulty are greater. Due to the impact of reduced movement and decreased appetite in the early postoperative period, the consequences will be more serious after wound infection. Studying the risk factors of early infection in elderly patients after lumbar surgery is helpful to understand the mechanism of the disease and take corresponding prevention and treatment measures. However, the risk factors for infection in elderly patients after lumbar surgery have not been reported in the literature. Therefore, this study retrospectively analyzed a group of elderly patients with lumbar spine postoperative infection in our hospital, to explore the risk factors of postoperative reinfection, and to provide some treatment ideas for clinical treatment.

Search strategies and selection criteria

This study was approved by the ethics committee of our hospital and informed consent was got from all patients before participation. A retrospective study was conducted and elderly patients who underwent posterior lumbar interbody fusion internal fixation due to degenerative lumbar diseases from January 2019 to December 2021 were included in this study. 18 patients with postoperative SSI were included in the infection group, including eight males and 10 females with a mean age of (69.4 ± 5.5) years. The causes included disc herniation in four cases, spinal stenosis in 11 cases and lumbar spondylolisthesis in three cases. In order to determine the differences between patients with SSI and without SSI, each SSI patient was matched with three controls who underwent posterior lumbar interbody fusion and internal fixation at the same period but without complications according to age, gender and diagnosis. The inclusion criteria were the following: (1) age ≥ 60 years; (2) Degenerative lumbar diseases, including lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis; (3) Traditional open posterior lumbar interbody fusion and internal fixation was performed; (4) Postoperative SSI; (5) Complete follow-up data. The exclusion criteria were: (1) age < 60 years old; (2) Lumbar specific infections, such as brucella spondylitis, lumbar tuberculosis, etc.; (3) Minimally invasive surgical treatment, such as Minimally invasive surgery-Transforaminal lumbar interbody fusion (MIS-TLIF); (4) preoperative waist skin infection, lung infection or urinary tract infection; (5) Incomplete follow-up data.

Diagnosis of SSI

In this study, SSI was specified as early spinal infection within 30 days after posterior lumbar interbody fusion. The elderly patients who met one or more of the following criteria would be diagnosed as SSI [4]: (1) the Surgical wound presented the symptoms or signs of redness, swelling, heat, pain, tenderness to palpation and/or purulent drainage; (2) there was abscess aspirated from the wound and the Bacterial culture was positive; (3) Fluid or tissue harvested from revision surgery was cultured positively; (4) evidences of SSI was confirmed by laboratory tests such as blood routine items, C-reactive protein (CRP), procalcitonin, histopathologic and radiologic examinations.

Data collection

All patients’ medical records were retrieved for the analysis. The preoperative, intraoperative and postoperative clinical data of elderly patients in the two groups were collected for the analysis, including the preoperative and postoperative laboratory tests. Preoperative indexes included sex, age, body mass index (BMI), diagnosis, smoking, hypertension, and diabetes mellitus. Intraoperative indexes included surgical duration, blood loss, transfusion or not, number of fusion segments and surgically fixed vertebrae. Postoperative indexes included drainage duration, atomization. Perioperative laboratory indexes included preoperative and 3 to 7 days after the operation, such as blood routine and serum albumin concentration.

Statistical analysis

The statistical analyzed were performed by SPSS 25.0 software. First, univariate analysis was conducted to identify the potential risk factors for SSI. Student t tests was used for quantitative variables conforming to normal distribution. The wilcoxon rank-sum test was used for quantitative variables that did not conform to normal distribution. Qualitative variables were analysed by Chi-square test. Then, mutilvariate Logistic regression analysis was performed to determine the independent risk factors for SSI using variables with P < 0.1 in univariate analysis (P value was appropriately extended to 0.1 to avoid missing of important variables) and variables closely related to SSI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Receiver operating characteristic (ROC) curve analysis was conducted for quantitative variables belonging to risk factors, and the cut-off value including the sensitivity and specificity of related variables was determined by Youden's index. A significant difference was set as P < 0.05.

Analysis of bacterial species in infected group

Among the 18 patients in the infection group, there were 16 patients with deep infection and two patients with superficial infection. Culture results of tissue and wound secretions showed that four cases were infected with Staphylococcus aureus, five with Escherichia coli, two with Staphylococcus epidermidis, one with Klebsiella pneumoniae, one with two types of bacteria (Escherichia coli and Klebsiella pneumoniae), one with Staphylococcus cephali, and the remaining four cases were not detected with bacteria. The cases of Staphylococcus aureus and Escherichia coli infection accounted for 55.6% (10/18) of the total cases, and 71.4% (10/14) of the cases with positive culture results.

Univariate analysis of clinical data of infected and control patients

There was no significant difference in preoperative indexes including gender, age, diagnosis, BMI, smoking status, hypertension and diabetes status between infection and control group (P > 0.05). For intraoperative indexes, surgical duration in the infection group was (197.1 ± 39.5) min and that in the control group was (171.4 ± 37.2) min (P < 0.05). No significant difference was observed for intraoperative blood loss, transfusion or not, the number of fusion segments and surgically fixed vertebrae (P > 0.05). There was no significant difference in postoperative indexes including the duration of catheter indwelling and atomization between the two groups (P > 0.05). In terms of laboratory data, there were no significant differences in preoperative laboratory indexes between the two groups except lymphocyte count (P > 0.05). Among postoperative laboratory indexes, the number of neutrophils, percentage of neutrophils, number of lymphocytes, percentage of lymphocytes, the neutrophil/lymphocyte count ratio (NLR) and serum albumin concentration were correlated with postoperative SSI (P < 0.05), while the differences of white blood cell (WBC) count, hemoglobin concentration and hematocrit (HCT) were not statistically significant (P ༞ 0.05). All perioperative monitoring indexes of patients in the two groups were demonstrated in Table 1.

Table 1

Univariate analysis of clinical indexes in the infection group and control group.
Variable	SSI (n = 18)	Control (n = 54)	P
Preoperative variables
Gender (male/female, n)	8/10	31/25	0.395
Age (years)	69.4 ± 5.5	68.2 ± 5.2	0.395
BMI (Kg/m²)	24.2 ± 3.3	24.9 ± 3.1	0.424
Diagnosis			0.180
Lumber disc herniation	4	24
Lumber spinal stenosis	11	21
Lumbar spondylolisthesis	3	9
Smoker (n, %)	4 (22.2)	17 (31.5)	0.454
hypertension (n, %)	10 (55.6)	28 (51.9)	0.785
Diabetes mellitus (n, %)	9 (50)	14 (25.9)	0.058
Intraoperative variables
Surgical duration (min)	197.1 ± 39.5	171.4 ± 37.2	0.015
Blood loss (ml)	750 (500–850)	600 (500–800)	0.605
Allogeneic blood Transfusion (n, %)	14 (77.8)	50 (92.6)	0.194
Number of fused segments (n)			0.777
1	6	20
≥ 2	12	34
Number of surgically fixed vertebrae (n)			0.072
2	1	5
3	3	20
4	7	17
≥ 5	7	12
Postoperative variables
Drainage duration (d)	5.5 (4-6.3)	6 (5–7)	0.766
Atomization (n, %)	8 (44.4)	35 (64.8)	0.127
Preoperative laboratory variables
WBC count (*10⁹/L)	5.9 ± 1.7	6.2 ± 1.6	0.391
Neutrophil count (*10⁹/L)	3.4 (2.8-4.0)	3.5 (2.7–4.4)	0.520
Neutrophil percentage (%)	59.7 ± 9.7	57.9 ± 7.4	0.400
Lymphocyte count (*10⁹/L)	1.6 ± 0.5	1.9 ± 0.6	0.041
Lymphocyte percentage (%)	28.1 ± 8.4	31.0 ± 6.6	0.136
NLR	2.1 (1.7–2.8)	1.8 (1.5–2.4)	0.140
Albumin (g/dl)	38.5 ± 3.1	38.8 ± 2.9	0.708
Hemoglobin (g/L)	131.6 ± 11.9	137.4 ± 15.3	0.143
HCT (L/L)	0.4 ± 0.0	0.4 ± 0.0	0.166
Postoperative laboratory variables
WBC count (*10⁹/L)	9.9 ± 2.7	8.7 ± 2.3	0.077
Neutrophil count (*10⁹/L)	7.2 (6.2–9.5)	6.3 (4.8–7.2)	0.040
Neutrophil percentage (%)	82.5 ± 8.8	71.1 ± 6.7	༜0.001
Lymphocyte count (*10⁹/L)	1.1 ± 0.6	1.7 ± 0.7	0.001
Lymphocyte percentage (%)	11.0 ± 5.6	19.8 ± 6.0	༜0.001
NLR	8.5 (5.2–15.0)	3.6 (2.6–4.9)	༜0.001
Albumin (g/dl)	31.4 ± 2.5	33.3 ± 2.4	0.005
Hemoglobin (g/L)	113.6 ± 16.7	116.6 ± 14.1	0.463
HCT (L/L)	0.3 ± 0.1	0.3 ± 0.0	0.486

Multivariate analysis of postoperative SSI

According to the results of univariate analysis, indexes with statistical differences between the two groups were selected. The P level can be appropriately relaxed to < 0.1 to avoid missing important factors. The indexes that might be related to postoperative SSI should also be selected based on clinical practice. The final selected indexes included: BMI, diabetes mellitus, surgical duration, number of fusion segments, number of surgically fixed vertebrae, postoperative atomization, preoperative lymphocyte count, postoperative laboratory indexes including neutrophil count, neutrophil percentage, lymphocyte count, lymphocyte percentage, NLR, serum albumin concentration. Multiple Logistic regression analysis was conducted with the above indexes as independent variables and SSI as dependent variables. It was finally concluded that diabetes status, surgical duration and postoperative percentage of neutrophils were independent risk factors for SSI, as detailed in Table 2.

Table 2

Multivariate logistic regression analysis of risk factors for postoperative SSI after lumbar spinal surgery.
Variable	B	SD	OR	95% CI	P
Diabetes mellitus (n)	1.894	0.860	6.649	1.233–35.853	༜0.05
surgical duration (h)	0.025	0.011	1.025	1.004–1.047	༜0.05
postoperative neutrophil percentage (%)	0.232	0.058	1.261	1.125–1.414	༜0.01

ROC curve analysis

ROC curves were drawn for quantitative variables identified as risk factors. AUC of the operation duration was 0.680, and the cut-off value was 177.5 min when Youden's index was 0.389. The sensitivity and specificity were 77.8% and 61.1%. AUC of postoperative neutrophil percentage was 0.841, reaching a critical value of 78.85% when Youden's index was 0.574, with a sensitivity of 66.7% and specificity of 90.7%. According to the characteristics of ROC curve, if the difference of AUC of different indexes is statistically significant (P < 0.05), the larger the AUC, the better the prediction effect. Then, Statistical significance test was conducted for the difference between the AUC of the surgical duration and the percentage of neutrophil after the operation (P = 0.11 > 0.05), which showed no statistical significance. The ROC curve is shown in Fig. 1(ROC curve of quantitative variables of risk factors for postoperative SSI).

As the population aged, the proportion of elderly patients undergoing posterior lumbar interbody fusion is gradually increasing every year. Compared with younger patients, elderly patients seemed to be more susceptible to SSI after surgery due to one or more underlying diseases, low immunity, poor nutritional status, and poor surgical tolerance. Once SSI is diagnosed, complications are likely to occur during treatment, such as pendulous pneumonia, urinary tract infection, osteoporosis, the spread of infection to the whole body causes bacteremia, even life-threatening, resulting in its harm, treatment cycle, difficulty, cost is also greater, affecting the surgical efficacy or postoperative rehabilitation. Therefore, it is more urgent to reduce the incidence of postoperative SSI in elderly patients. Previous literatures have showed that the risk factors for SSI after lumbar surgery include self-related factors, perioperative related factors and laboratory indexes. If further research can be carried out from these aspects, the risk factors of postoperative SSI in elderly patients can be obtained, and effective prevention and treatment measures can be taken in time to reduce the incidence of SSI. The final results of the study showed that diabetes mellitus, longer surgical duration and high percentage of neutrophils after surgery were independent risk factors for postoperative SSI in elderly patients.

Diabetes mellitus is a proven risk factor for SSI after lumbar surgery. The pathogenic mechanism is that diabetes can cause microvascular lesions, resulting in tissue ischemia and hypoxia around the incision, and high blood sugar will inhibit the immune function of the body, eventually leading to slow incision healing and even infection [3]. Previous studies have shown that the risk of SSI in patients with diabetes mellitus was 1–2 times that of non-diabetic patients [5, 6]. The results of this study also confirm that diabetes mellitus is an independent risk factor for SSI in elderly patients after lumbar surgery. However, it was found that the risk of SSI in elderly patients with diabetes was 6.649 times higher than that in non-diabetic patients, which was higher than previous studies.Therefore, it is speculated that elderly diabetic patients are more susceptible to SSI after surgery compared with younger patients. Previous studies have shown that in order to reduce the risk of postoperative SSI in patients with diabetes, the blood glucose levels must be strictly controlled within the normal range, otherwise spinal surgery should not be performed [7]. But for elderly patients, blood glucose levels cannot be reduced blindly. Because of the poor perception and regulation of the elderly, it is easy to appear hypoglycemia in the treatment process [8, 9], which is easy to damage the heart function and nervous system [10, 11]. In addition, as elderly patients are often complicated with osteoporosis and chronic hyperglycemia can aggravate bone loss [12], fractures are more likely to occur if hypoglycemic syncope occurs. Therefore, for elderly patients with diabetes mellitus, the fluctuation range of perioperative blood glucose can be appropriately relaxed to reduce the harm caused by both hyperglycemia and hypoglycemia.

Longer surgical duration has an important effect on the occurrence of SSI after surgery. Qi Fei et al. found that surgical duration exceeding three hours was an independent risk factor for SSI after spinal surgery [13]. Schoenfeld et al. showed that surgical duration exceeding 309 min could increase the risk of postoperative SSI [14]. The pathogenesis is that If the surgical duration is prolonged, on the one hand, the exposure time of the inner plant is prolonged, and the bacteria in the air can adhere to its surface. On the other hand, the colonizing bacteria on the skin surface can be transferred into the incision. In addition, longer operation duration will increase blood loss, decrease the blood concentration of antibiotics, lead to local tissue ischemia and hypoxia due to prolonged stretch of soft tissue. The results of this study also found that longer operation duration was more likely to lead to postoperative SSI. Moreover, the ROC curve showed that the critical value was 177.5min, and the sensitivity was higher than the specificity. If the operation duration exceeded 177.5min, the risk of SSI would be increased. Therefore, the surgical duration and the incidence of postoperative SSI can be reduced by optimizing the preoperative operation plan, intraoperative proficiency and hemostatic effect, the control of operating room personnel flow, and the maintenance of antibiotic blood concentration.

Postoperative SSI can also be predicted by monitoring changes in perioperative laboratory indexes. Studies have shown that early postoperative changes in CRP and Erythrocyte sedimentation rate (ESR) levels were helpful for early diagnosis of SSI [15]. However, they also have certain deficiencies. CRP is highly sensitive (95%), but has low specificity (31%) [16], and is easily affected by blood loss and preoperative CRP level. The change of ESR value is slow, reaching a peak at two weeks after surgery and returning to normal at six weeks, and its sensitivity is lower than that of CRP. Therefore, additional indexes are needed for further diagnosis. This study found that neutrophil percentage at three to seven days after surgery was an independent risk factor for SSI after lumbar spine surgery, which has not been reported in previous studies. According to ROC curve, AUC of neutrophil percentage was 0.841, which could be used as an effective predictor. The sensitivity and specificity were 66.7% and 90.7%, respectively. The specificity was higher than the sensitivity, indicating that the possibility of SSI could be excluded when the percentage of neutrophil was lower than 78.85% after surgery, which was more used as an exclusion index. Therefore, it can make up for the deficiency of CRP and ESR, and the combined application of the three can predict the occurrence of SSI more accurately in the early postoperative period. In addition, compared with CRP, ESR and other indexes to predict infection, the percentage of neutrophil is more widely used and more convenient, quick and economical to obtain.

According to the study of Zhongyuan He et al, serum albumin concentrations below 3.5 g/dl before surgery and 3.0 g/dl after surgery were risk factors for SSI [17]. Chao-Jun Shen et al. found that NLR at 4 and 7 days after surgery was an effective index for predicting the occurrence of SSI [18]. However, in this study, serum albumin concentration and NLR could not be used as effective predictors, which was different from previous studies. It may be because the above indexes were not suitable for elderly patients, or this study was a retrospective study and the number of included cases is small, which was prone to bias.

The pathogenic bacteria of SSI after lumbar spine surgery can be classified according to the degree of virulence, Staphylococcus aureus and Gram-negative bacteria are more virulent, coagulase negative staphylococcus is less virulent[19]. S. aureus is the most common pathogen found in SSI, but gram-negative bacteria are also found at a higher rate in Lower lumbar and sacral spine surgery [20]. In the infection group of this study, the pathogenic microorganisms cultured through the incision were mainly Staphylococcus aureus and Escherichia coli, which was more destructive to the body and difficult to control. The reason is that elderly patients have poor tissue repair ability and operation tolerance, low immunity and poor nutritional status, so they are susceptible to virulent pathogens. Therefore, in the perioperative period, it is necessary to improve the immunity, strengthen nutrition, reasonably control underlying diseases, and shorten the operation duration of elderly patients. In addition, preventive and empirical application of appropriate antibiotics before and after surgery is also necessary to reduce the occurrence of postoperative SSI.

There are some limitations to this study. This study is a single-center retrospective study, and the selection of cases may be biased. The infected cases collected were all early infected cases. The included sample size was small and only included elderly patients with degenerative diseases of the lumbar spine, resulting in risk factors reported in the previous literature not being confirmed in this study. Later, the sample size should be expanded and prospective studies conducted to obtain more accurate data.

This study revealed that diabetes mellitus, surgical duration longer than three hours, and increased neutrophil percentage within one week after surgery were independent risk factors for early postoperative SSI in elderly patients with lumbar degenerative disease undergoing posterior lumbar interbody fusion. However, we should also pay close attention to the changes of other infectious indexes, and take effective measures in time to reduce the infection rate and promote patients to recover as soon as possible.

SSI: Surgical site infection; ROC: Receiver operating characteristic; NLR: Neutrophil/lymphocyte count ratio; AUC: Area under the curve; MIS-TLIF: Minimally invasive surgery-Transforaminal lumbar interbody fusion; CRP: C-reactive protein; BMI: Body mass index; ORs: Odds ratios; CIs: Confidence intervals; WBC: White blood cell; HCT: Hematocrit; ESR: Erythrocyte sedimentation rate.

Ethics approval and consent to participate

This study was approved by the medical ethics committee of Shanxi Bethune hospital (YXLL-2021-008).

Consent for publication

The consent for publications have be obtained from that all patients before participation.

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Authors' contributions

GH collected, analyzed and interpreted data on the risk factors of surgical incision infection in the elderly after lumbar spinal surgery and was a major contributor in writing the manuscript. ZX was responsible for the design of the study and the critical revision of the manuscript's important knowledge content.All authors read and approved the final manuscript.

Acknowledgements

The authors thank QingQing Liu from the Department of Orthopedics, Shanxi Bethune Hospital for providing guidance on data statistics. Thanks to XingHua Ji and HaoYu Feng for their input in the development of the research questions and methods.

Sasso RC, Garrido BJ. Postoperative spinal wound infections. J Am Acad Orthop Surg. 2008 Jun;16(6):330–7. doi: 10.5435/00124635-200806000-00005.
Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008 Jan;90(1):62–9. doi: 10.2106/JBJS.F.01515.
Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976). 2009 Jun 1;34(13):1422-8. doi: 10.1097/BRS.0b013e3181a03013.
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017 Aug 1;152(8):784–791. doi: 10.1001/jamasurg.2017.0904.
Liu JM, Deng HL, Chen XY, Zhou Y, Yang D, Duan MS, Huang SH, Liu ZL. Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery. Spine (Phila Pa 1976). 2018 May 15;43(10):732–737. doi: 10.1097/BRS.0000000000002419.
Mehta AI, Babu R, Sharma R, Karikari IO, Grunch BH, Owens TR, Agarwal VJ, Sampson JH, Lad SP, Friedman AH, Kuchibhatla M, Bagley CA, Gottfried ON. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. J Bone Joint Surg Am. 2013 Feb 20;95(4):323–8. doi: 10.2106/JBJS.L.00225.
Zhang X, Liu P, You J. Risk factors for surgical site infection following spinal surgery: A meta-analysis. Medicine (Baltimore). 2022 Feb 25;101(8):e28836. doi: 10.1097/MD.0000000000028836.
Lai Q, Song Q, Guo R, Bi H, Liu X, Yu X, Zhu J, Dai M, Zhang B. Risk factors for acute surgical site infections after lumbar surgery: a retrospective study. J Orthop Surg Res. 2017 Jul 19;12(1):116. doi: 10.1186/s13018-017-0612-1.
ORIGIN Trial Investigators. Predictors of nonsevere and severe hypoglycemia during glucose-lowering treatment with insulin glargine or standard drugs in the ORIGIN trial. Diabetes Care. 2015 Jan;38(1):22–8. doi: 10.2337/dc14-1329.
Lipska KJ, Yao X, Herrin J, McCoy RG, Ross JS, Steinman MA, Inzucchi SE, Gill TM, Krumholz HM, Shah ND. Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006–2013. Diabetes Care. 2017 Apr;40(4):468–475. doi: 10.2337/dc16-0985.
Feinkohl I, Aung PP, Keller M, Robertson CM, Morling JR, McLachlan S, Deary IJ, Frier BM, Strachan MW, Price JF; Edinburgh Type 2 Diabetes Study (ET2DS) Investigators. Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes Care. 2014 Feb;37(2):507–15. doi: 10.2337/dc13-1384. Epub 2013 Oct 8.
Scheen AJ, Charbonnel B. Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: a critical reappraisal. Diabetes Metab. 2014 Jun;40(3):176–85. doi: 10.1016/j.diabet.2014.03.004. Epub 2014 Apr 30.
Sarodnik C, Bours SPG, Schaper NC, van den Bergh JP, van Geel TACM. The risks of sarcopenia, falls and fractures in patients with type 2 diabetes mellitus. Maturitas. 2018 Mar; 109:70–77. doi: 10.1016/j.maturitas.2017.12.011. Epub 2017 Dec 15.
Fei Q, Li J, Lin J, Li D, Wang B, Meng H, Wang Q, Su N, Yang Y. Risk Factors for Surgical Site Infection After Spinal Surgery: A Meta-Analysis. World Neurosurg. 2016 Nov;95:507–515. doi: 10.1016/j.wneu.2015.05.059. Epub 2015 Jun 6.
Schoenfeld AJ, Carey PA, Cleveland AW 3rd, Bader JO, Bono CM. Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patients. Spine J. 2013 Oct;13(10):1171–9. doi: 10.1016/j.spinee.2013.02.071. Epub 2013 Apr 9.
Chahoud J, Kanafani Z, Kanj SS. Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. Front Med (Lausanne). 2014 Mar 24; 1:7. doi: 10.3389/fmed.2014.00007.
Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine. 2010 Aug;13(2):158–64. doi: 10.3171/2010.3.SPINE09403.
He Z, Zhou K, Tang K, Quan Z, Liu S, Su B. Perioperative hypoalbuminemia is a risk factor for wound complications following posterior lumbar interbody fusion. J Orthop Surg Res. 2020 Nov 17;15(1):538. doi: 10.1186/s13018-020-02051-4.
Shen CJ, Miao T, Wang ZF, Li ZF, Huang LQ, Chen TT, Yan WH. Predictive value of post-operative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery. Int Immunopharmacol. 2019 Sep;74:105705. doi: 10.1016/j.intimp.2019.105705. Epub 2019 Jun 19.
Sampedro MF, Huddleston PM, Piper KE, Karau MJ, Dekutoski MB, Yaszemski MJ, Currier BL, Mandrekar JN, Osmon DR, McDowell A, Patrick S, Steckelberg JM, Patel R. A biofilm approach to detect bacteria on removed spinal implants. Spine (Phila Pa 1976). 2010 May 20;35(12):1218–24. doi: 10.1097/BRS.0b013e3181c3b2f3.
Abdul-Jabbar A, Berven SH, Hu SS, Chou D, Mummaneni PV, Takemoto S, Ames C, Deviren V, Tay B, Weinstein P, Burch S, Liu C. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine (Phila Pa 1976). 2013 Oct 15;38(22): E1425-31. doi: 10.1097/BRS.0b013e3182a42a68.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Analysis of risk factors for early surgical site infection after lumbar spinal surgery in elderly patients

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Background

Methods

Search strategies and selection criteria

Diagnosis of SSI

Data collection

Statistical analysis

Results

Analysis of bacterial species in infected group

Univariate analysis of clinical data of infected and control patients

Multivariate analysis of postoperative SSI

ROC curve analysis

Discussion

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1