Risk and Protective Factors Associated with Surgical Infections among Spine Patients

The purpose of the study was to identify patient-specific and procedure-specific risk and protective factors associated with post-operative surgical site infections (SSIs) among surgical spine patients.

CINAHL, PubMed, Ovid, Medline, and EBSCO databases were searched for articles within the past 10 years (January 2003-March 2015). The keywords and combinations used in the search included: Spine surgery, post-operative infection, risk factors, orthopedic infections. The search resulted in 842 articles of which 29 met inclusion criteria. This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses guidelines.

Evidence about patient-specific and procedure-specific factors associated with increased risk of post-operative SSIs among patients undergoing orthopedic spinal surgery is inconclusive. Gender (male), age, body mass index, cigarette smoking, diabetes mellitus, a history of infection and alcohol abuse were identified as common patient-specific risk factors. Blood transfusion, implantation, and steroid use were found to increase SSIs in certain studies and associated with no significant difference in other studies. Protective factors include the implementation of pre-operative elements to reduce infection; protocols addressing patient-related factors (smoking, weight, glucose) and operation-related factors (antibiotic prophylaxis, prosthetics, length of operation, and pre-operative cultures); incision drains placed intra-operatively; anterior approach; laminar-flow operating theater, and skin antisepsis using chlorhexidine.

Interventions focusing on minimizing patient-specific risk factors and operation-specific risk factors and optimizing patient-specific protective factors and operation-specific protective factors are most effective in minimizing the likelihood of a post-operative infection among patients undergoing orthopedic spinal surgical procedures. The studies reviewed provide conflicting evidence relative to risk and protective factors.