Risk Factors for Surgical Site Infections Following Spinal Surgery: A Systematic Review

Introduction: The complication rate for spinal surgery in the United States is 16.4%, and the incidence of surgical site infection (SSI) is 1-4%. These complications increase morbidity and healthcare costs. Knowledge of the risk factors for SSI can improve pre- and post-operative care to improve patient outcomes. However, there are few studies that compare how alterations in care routines can reduce these rates. This systematic review summarizes the findings for risk factors of SSI over the last 14 years.

Methods: A systematic search was completed using PubMed, Web of Science, and Scopus. Two independent reviews completed a title screening, abstract screen, and full text review of the articles. Disputes were resolved via a third reviewer. Data from each article, including participant information and outcomes was recorded. The risk factors that were found to be significant in each study were compared.

Results: Based on 32 publications that assessed risk factors associated with SSI, increased BMI, comorbidity of diabetes mellitus, increased operation time, or a greater number of surgical levels were risk factors most commonly found for SSI. Age, smoking status, and sex of the patient were commonly found not to be predictive of incidence of SSI.

Conclusion : SSI following spinal surgery leads to increased morbidity, mortality, and overall hospital costs. Understanding the risk factors for these complications can help prophylactically treat patients and avoid worse outcomes. Further research is needed to prospectively study how hospital care targeted toward reducing risks of SSI can impact hospital mortality and length of stay.