Risk factors for surgical site deep infection after posterior instrumented lumbar fusion

English Keywords:Lumbar degenerative disease  Posterior instrumented lumbar fusion  Surgical site deep infection  Risk factors

English Abstract:

  【Abstract】 Objectives: Retrospective analysis of the clinical data of deep incision infection in posterior lumbar surgery and no infection in the same period of operation, and to determine the risk factors of deep incision infection. Methods: This study retrospectively analyzed 907 patients with degenerative diseases of the lumbar spine who underwent posterior instrumented lumbar fusion in the spinal surgery department of our hospital from January 2013 to December 2018 and were followed up for more than 1 year. The medical records of all patients were collected, and the cases of postoperative deep incision infection were determined according to the diagnostic criteria of deep incision infection. The patients were divided into the infected group and the non-infected group. Univariate and multivariate Logistic regression was used to analyze the age, sex, body mass index(BMI), smoking, drinking, diabetes, hypertension, gout, urinary tract infection, lung disease, hematological indexes before operation, operation-related factors, blood transfusion volume, postoperative albumin and postoperative indwelling catheter time to determine the risk factors of deep incision infection. Results: A total of 907 patients were included in the study, 20 of whom met the diagnostic criteria for deep incision infection, 10 males and 10 females, with an average age of 58.9±7.8 years. Univariate analysis showed that age, BMI>25kg/m2, alcohol exposure, diabetes mellitus, urinary tract infection and blood transfusion were associated with infection. Multivariate Logistic regression analysis(Backward LR method) showed that BMI>25kg/m2(P=0.031), alcohol exposure(P=0.049), diabetes(P=0.006), urinary tract infection(P<0.001), less postoperative drainage(P=0.040), and postoperative blood transfusion(P=0.001) were independent risk factors for deep incision infection. Urinary tract infection, diabetes, alcohol exposure and BMI>25kg/m2 were the four strongest risk factors for surgical site deep infection(OR 14.92, 5.53, 3.10, 2.78). Conclusions: Preoperative urinary tract infection, diabetes, history of alcohol consumption, BMI>25kg/m2, less postoperative drainage and more blood transfusion are independent risk factors of surgical site deep infection after posterior fixation and fusion of lumbar degenerative diseases, the corresponding measures are helpful to reduce the incision infection rate.