The risk factors and treatment strategies of surgical site infection after posterior spinal internal fixation surgery

English Keywords:Posterior spinal surgery  Surgical site infection  Risk factors  Prevention and treatment

English Abstract:

  【Abstract】 Objectives: To explore the risk factors and treatment strategies of surgical site infection after posterior spinal internal fixation surgery. Methods: A retrospective analysis was performed on 3780 patients who underwent posterior spinal internal fixation surgery in the orthopedics department of our hospital from January 2015 to January 2018. There were 1970 males and 1810 females, aged 18-92 years(44.9±18.4 years), with a follow-up of 1.5±0.3 years. Patients were divided into infected group and non-infected group according to whether there was infection after operation. The data of the patients in both groups collected for independent sample t test included: whether aged >60 years old and the gender; whether combined with the body mass index(BMI) >30kg/m2; whether combined with the fusion segments >2; whether combined with the operation time >3h; whether combined with the hypoalbuminemia(albumin <35g/L); whether combined with anemia; whether combined with diabetes; whether combined with allogeneic blood transfusion; whether combined with postoperative drainage time >48; whether combined with the blood loss >1000ml; and whether combined with other site infection. The positive results were further analyzed by multivariate Logistic regression. The infected group was divided into superficial infection group and deep infection group according to the infection site across the deep fascia or not. The bacterial type results of the infected group were collected, and the pathogen composition ratio was analyzed by χ2 test. Results: Surgical site infection occurred in 95 out of the 3780 patients, with an infection incidence of 2.51%, including 52 males and 43 females, aged 18-82 years(43.5±15.2 years). Univariate analysis showed that there was no statistically significant difference between the two groups in gender, BMI >30kg/m2, fusion segment, anemia, allogeneic blood transfusion, postoperative drainage time, and combined with other site infection(P>0.05). However, there were statistically significant differences in age >60 years old, the operation time >3h, hypoproteinemia(albumin <35g/L), diabetes mellitus, and blood loss >1000ml(P<0.05). Multivariate Logistic regression results showed that the age >60 years old(OR=5.267, P=0.008), the operation time >3h(OR=7.156, P=0.000), hypoproteinemia(OR=4.358, P=0.016), diabetes mellitus(OR=3.578, P=0.005) and the blood loss >1000ml(OR=4.659, P=0.007) were independent risk factors for surgical site infection after posterior spinal internal fixation surgery. According to the infection site, the 95 patients with surgical site infection after posterior spinal surgerywere divided into superficial infection (65 cases) and deep infection(30 cases). The constituent ratios of pathogens were not statistically significant(P<0.05). Conclusions: Patients with age >60 years old, operation time >3h, hypoproteinemia, diabetes and blood loss >1000ml after posterior spinal internal fixation surgery have a higher risk of incisional infection. Effective treatment strategies should be actively adopted during the perioperative period to minimize the occurrence of surgical site infection after spinal internal fixation surgery.