Risk Factors for Surgical Site Infection After Spinal Surgery: A Systematic Review and Meta-Analysis Based on Twenty-Seven Studies

The present meta-analysis was conducted to explore and identify the risk factors for surgical site infection (SSI) after spinal surgery based on qualified studies and to gain insight into the management of SSI among patients undergoing spinal surgery. We searched the following electronic databases, PubMed, the Cochrane Library, and the Embase database, updated to May 2018, to identify eligible studies according to the index words with associated publications. The odds ratios and 95% confidence intervals were used to analyze the main outcomes. We found 27 studies with a total of 2175 patients in the SSI group and 41,536 patients in the control group for the present meta-analysis. The pooled results revealed that the risk factors for SSI included diabetes, obesity, hypertension, ≥3 hours operative time, and transfusion. In addition, no significant association was found between SSI and the following risk factors: female gender, age >60 years, smoking habit, bone autograft, bone allograft, prophylactic antibiotics, and steroid therapy. Our findings provide evidence that diabetes, obesity (body mass index >30 kg/m2), hypertension, ≥3 hours operative time, and transfusion have a strong association with a remarkable increase in the risk of SSI after spinal surgery. In conclusion, more high-quality trials with larger sample sizes and long-term randomized controlled trials are warranted to confirm the risk factors for SSI among patients undergoing spinal surgery.