Surgical site infections in canine tibial plateau leveling osteotomy: a systematic review and meta-analysis

Surgical site infections (SSIs) following canine tibial plateau leveling osteotomy (TPLO) represent a significant clinical concern. A universal estimate of SSI incidence and identification of predisposing factors can guide preventive strategies.

This systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (ie, PRISMA) guidelines. Studies reporting outcomes of TPLO procedures published between January 2000 and August 2024 were included. AGRICOLA, BIOSIS Previews, ProQuest Dissertations and Theses Global, PubMed, Scopus, VetMed Resource, and Web of Science Core Collection were searched on August 23, 2024. The AVMA Clinical Trials Registry, International Veterinary Information Service, and World Organisation for Animal Health were searched on September 21, 2024. Two gray literature sources, American College of Veterinary Surgeons Surgery Summit Abstracts and Veterinary Orthopedic Society Conference Abstract Archive, were hand-searched by subject experts on the same date. Studies were excluded if they did not examine dogs that had undergone TPLO surgery, were written in a language other than English, were published before the year 2000, were not a primary study, did not report factors that affected incidence with included data, were performed by a nonspecialist surgeon, or were not performed at an academic or specialty private practice veterinary hospital. The number of SSIs and factors affecting SSI development were extracted. Random-effects meta-analysis was used to estimate a pooled SSI incidence rate. Relative risks with 95% CIs for SSI incidence were calculated for prospective interventions and for studies comparing TPLO with alternative procedures.

Of 10,125 publications screened, 119 (93 retrospective and 26 prospective) were included. The pooled estimate for SSI incidence was 5.6% (95% CI, 4.4% to 7.2%); 69% and 73% of retrospective and prospective manuscripts, respectively, failed to report a follow-up time of 1 year for procedures with permanent implants. Limitations included the application of AI with a "human in the loop," limited sensitivity tools available for clinical surgical research, a small number of eligible prospective comparative studies, heterogeneity across the reports, and inability to undertake meta-regression on clinically plausible moderators owing to a lack of raw original data from authors.

This pooled estimate and CI can be used as a baseline to identify new single and bundled interventions to reduce the incidence of SSIs in TPLO procedures. Given the emotional and financial cost of SSIs in TPLOs and increasing antibiotic resistance, a standardized multi-institutional SSI reporting database is recommended to adequately power clinical research studies and establish best practices for reducing SSIs. The use of triclosan-coated suture material in TPLO procedures could be tested independently for its effect in reducing SSIs.