General Session: Tumor, Trauma, Infection - Hall F

Presented by: T. Pannu

Author(s):

S. Pesenti(1), T. Pannu(2), J. Andres Bergos(2), J. Smith(3), S. Glassman(4), F. Pellise(5), M. de Kleuver(6), D. Sciubba(7), V. Lafage(2), F. Schwab(2)

(1) Hopital d'Enfants de la Timone, Marseille, France
(2) Hospital for Special Surgery, New York, NY, United States
(3) University of Virginia, Charlottesville, VA, United States
(4) Norton Leatherman Spine Center, Louisville, KY, United States
(5) Hospital Universitari Vall Hebron, Barcelona, Spain
(6) VU University Medical Center, Amsterdam, Netherlands
(7) Johns Hopkins University, Baltimore, MD, United States

Abstract

Introduction: Although many risk factors for SSI have been described in the literature, methodologies and study cohorts vary widely. This meta-analysis sought to review the existing data and isolate significant risk factors for SSI in patients undergoing ASD surgery.

Purpose: To do systematic review of the published data on risk factors for SSI and identify significant risk factors for SSI in ASD surgery. Design: Meta-analysis

Methods: PubMed Medline, Embase and Cochrane databases were reviewed. Studies including either ASD patients or patients undergoing spinal fusion surgery (single or multilevel, anterior, posterior or combined approach) were considered. Studies that included an odds ratio (OR) for SSI or sufficient data to calculate an OR were included. A meta-analysis was performed using RevMan 5.1. Depending on heterogeneity (I2), OR with 95% CIs were calculated using either the fixed-effects model (when I2 >60%) or the random-effects model (when I2 < 60%).

Results: 6,480 unique manuscripts were identified and reviewed. 26 manuscripts with 425,565 patients met the criteria for inclusion. A total of 9 significant risk factors for SSI were identified and grouped into two different categories (Table). Patient-related factors for SSI included obesity, diabetes, ASA score, tobacco use and age. Surgical risk factors included revision surgery, OR time, use of osteotomy and number of levels fused.

Conclusion: This meta-analysis identifies significant risk factors for SSI following spine arthrodesis. This included modifiable patient factors such as obesity, diabetes and smoking status and non-modifiable risk factors like ASA score and age. Surgical risk factors included revision status, OR time, osteotomy use and number of levels fused. These factors should be considered in patient counseling as well as treatment approach and surgical strategy.

Risk factors for SSI after spine surgery