Risk factors of surgical site infection after minimally invasive transforaminal lumbar interbody fusion under Quadrant tube

English Keywords:Minimally invasive transforaminal lumbar interbody fusion  Surgical site infection  Complications  Risk factors

English Abstract:

  【Abstract】 Objectives: To explore the risk factors of surgical site infection(SSI) after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) under Quadrant tube. Methods: The data of patients who underwent MIS-TLIF under Quadrant tube in Department of Orthopaedics, Liangping District People′s Hospital, from January 2015 to December 2018 was collected in the retrospective study. The patients with SSI after operation were enrolled in SSI group. In the same period, the patients without SSI were randomly selected as non-infected group according to 1:4 ratio. The risk factors of infection after spinal surgery in previous studies were collected, including demographics, such as age, sex, body mass index(BMI), smoking, diabetes mellitus, hypertension,lumbar disease type, and preoperative laboratory serological markers: glycosylated hemoglobin, serum albumin, serum globulin, red blood cells, white blood cells, thrombocyte, serum potassium, serum calcium, and operation related markers: operation time, intraoperative blood loss, operation level, number of fusion segments. The above data were analyzed by univariate analysis between the two groups, and the indicators with significant statistical differences were screened and further analyzed in the Binary Logistic regression to explore the risk factors related to SSI, and drew the receiver operating characteristic curve(ROC). Results: A total of 679 patients were enrolled, 25 of whom had SSI and were assigned to the SSI group, the incidence of SSI was 3.68%(25/679). Meanwhile, 100 blank control patients without SSI were randomly selected and assigned to the non-infected group. Univariate analysis showed that age, BMI, smoking, diabetes mellitus, glycosylated hemoglobin, serum albumin, operation time, intraoperative blood loss, and number of fusion segments were significantly different between the two groups(P<0.05), while there was no significant difference in sex ratio, hypertension, lumbar disease type, serum globulin, red blood cells, white blood cells, thrombocyte, serum potassium, serum calcium, and operation level(P>0.05). Logistic analysis showed that age(OR＝1.077, 95%CI 1.003-1.156, P=0.042), body mass index(OR＝1.251, 95%CI 1.004-1.559, P=0.046), glycosylated hemoglobin(OR＝2.368, 95%CI 1.457-3.801, P<0.001), serum albumin(OR＝0.877, 95%CI 0.773-0.977, P=0.044) and operation time(OR＝1.026, 95%CI 1.003-1.050, P=0.029) were risk factors of SSI after MIS-TLIF. The cut-off value of glycosylated hemoglobin on ROC curve was 7.60%. Conclusions: Elderly patients, obesity, preoperative high glycosylated hemoglobin, low serum albumin and long operation time increase the risk of surgical site infection after MIS-TLIF.