Risk factors for surgical site infection following posterior internal fixation of thoracolumbar fractures

Surgical site infection (SSI) following posterior internal fixation of thoracolumbar fractures constitutes a severe complication that adversely impacts patient recovery. Despite its clinical significance, there remains a paucity of research investigating the risk factors associated with SSI. Therefore, this study aimed to explore these risk factors and propose potential therapeutic strategies.

A retrospective analysis was conducted on 157 patients who underwent posterior internal fixation for thoracolumbar fractures at the Department of Orthopedics, Affiliated Hospital of Yan'an University, between February 2017 and October 2021. Patients were stratified into an infection group (n = 12) and a non-infection group (n = 145). Preoperative baseline data included age, gender, body mass index, total protein (TP), albumin (ALB), hemoglobin (HB), red blood cell count (RBC), white blood cell count (WBC), total lymphocyte count (TLC), platelet count (PLT), and the presence of diabetes or hypertension. Operative data encompassed preoperative preparation time, length of the surgical incision, number of internal fixation segments, operation duration (≥3 h vs. <3 h), occurrence of allogeneic blood transfusion, intraoperative blood loss (≥400 mL vs. <400 mL), and type of drainage tube (negative-pressure vs. normal). Postoperative management-related data included dressing changes at the surgical incision within 24 h following the operation, indwelling time of the drainage tube (≥3 days vs. <3 days), drainage volume upon removal of the drainage tube (≥50 mL vs. <50 mL), reoperation requirement, and postoperative levels of TP, ALB, HB, RBC, WBC, TLC, and PLT. Eligible data were subjected to univariate analysis, followed by multivariate logistic regression for variables with significant univariate associations.

Univariate analysis revealed significant differences between groups in intraoperative blood loss (≥400 mL), preoperative ALB (<30 g/L), preoperative RBC, postoperative HB, postoperative RBC, surgical incision length, and number of internal fixation segments between groups (all P < 0.05). Multivariate logistic regression analysis identified preoperative hypoalbuminemia (<30 g/L) [odds ratio (OR) = 0.851, P = 0.028] and intraoperative blood loss (≥400 mL) (OR=7.477, P = 0.005) as independent risk factors for SSI.

Preoperative hypoalbuminemia (<30 g/L) and intraoperative blood loss (≥400 mL) are associated with an elevated risk of SSI following posterior internal fixation of thoracolumbar fractures. Implementing effective perioperative management strategies is crucial to mitigate the incidence of SSI.