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Factors predicting surgical site infection after posterior lumbar surgery

A multicenter retrospective study

Wang, Tao MDa; Wang, Hui MDa; Yang, Da-Long MDa; Jiang, Li-Qiang MDb; Zhang, Li-Jun MDc; Ding, Wen-Yuan MDa,*

Section Editor(s): Schaller., Bernhard

doi: 10.1097/MD.0000000000006042
Research Article: Observational Study: PDF Only

This is a retrospective study.

The purpose of this study is to explore incidence and risk factors for surgical site infection (SSI) after posterior lumbar surgery.

SSI is a common complication after posterior lumbar surgery, bringing mental and physical pain and prolonging hospital stay. However, predisposing factors, as reported less, remain controversial.

Patients who underwent posterior lumbar surgery at 3 centers between 2006 and 2016 were included. The possible factors include 3 aspects: demographic variables-age, sex, body mass index (BMI), waist-to-hip radio (WHR), hypertension, diabetes, heart disease, smoking, drinking, steroidal injection, surgical time between June and September, preoperative shower; blood test variables-white blood cell (WBC), neutrophil, red blood cell (RBC), hemoglobin (Hb), total protein (TP), albumin, albumin/globulin (A/G), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and surgical related variables-operation time, blood loss, operative level, instrumentation, incision length. Factors related with SSI were also performed by multivariate analysis.

The prevalence of SSI was 3.00% (267 cases of 8879) had a postoperative wound infection. There were significant difference in WHR (0.92 vs 0.83), WBC (4.31 vs 6.69), TP (58.7 vs 65.2), albumin (36.9 vs 43.2), CRP (2.01 vs 0.57), PCT (0.097 vs 0.067), operation time (217.9 vs 195.7), blood loss (997.1 vs 915.3) and operative level (3.05 vs 2.45) and incision length (24.1 vs 20.0) between SSI group and non-SSI group. >60 years old, female, BMI <18.5 and >30.0, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, no preoperative shower, instrumentation surgery were risk factors for SSI after posterior lumbar surgery.

Many factors, >60 years old, female, BMI, WHR, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, preoperative shower, WBC, TP, albumin, CRP, PCT, operation time, blood loss and operative level, instrumentation surgery and incision length, could predict SSI after posterior lumbar surgery. Measure should be taken before surgery to lower incidence of SSI after surgery.

aDepartment of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang

bDepartment of Orthopaedics, HanDan Central Hospital, HanDan

cDepartment of Orthopaedics, The First Hospital of Shijiazhuang, Shijiazhuang, China.

Correspondence: Wen-Yuan Ding, Department of Spinal Surgery, The Third Hospital of Hebei Medical University No. 139 Ziqiang Road, Shijiazhuang 050051, China (e-mail:

Abbreviations: A/G = albumin/globulin, BMI = body mass index, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, Hb = hemoglobin, PCT = procalcitonin, RBC = red blood cell, SSI = surgical site infection, TP = total protein, WBC = white blood cell, WHR = waist-to-hip radio.

Authors’ contributions—conceived and designed the study: W-YD; collected data: TW, HW, D-LY; analyzed the data: TW, L-QJ, and L-JZ;

wrote the paper: TW and HW.

TW, HW, D-LY, L-QJ, and L-JZ contributed equally to this study.

The authors have no conflicts of interest to disclose.

This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms.

Received November 17, 2016

Received in revised form January 10, 2017

Accepted January 11, 2017

Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.