What are the risk factors for surgical site infection after spinal fusion? A meta-analysis
verfasst von:
Sebastien Pesenti, Tejbir Pannu, Jessica Andres-Bergos, Renaud Lafage, Justin S. Smith, Steve Glassman, Marinus de Kleuver, Ferran Pellise, Frank Schwab, Virginie Lafage, on behalf of the Scoliosis Research Society (SRS)
Although many risk factors for surgical site infection (SSI) following spinal fusion have been described in the literature, methodologies and study cohorts vary widely. Patient- and procedure-specific risk factors for (SSI) can be identified via a meta-analysis. We sought to review the existing data and isolate significant risk factors for SSI in patients undergoing thoracolumbar spinal fusion.
Methods
The literature was searched through December of 2016. Studies including adult patients undergoing thoracolumbar spinal fusion surgery (single or multilevel, anterior, posterior or combined approach) were identified. Only studies that included an odds ratio (OR) for SSI or sufficient data to calculate it were included. A meta-analysis was performed using RevMan 5.1. Depending on heterogeneity (I2), OR with 95% confidence intervals was calculated using either the fixed-effects model (when I2 < 60%) or the random-effects model (when I2 > 60%).
Results
6482 manuscripts were identified and reviewed. 29 manuscripts with 374,488 patients met the criteria for inclusion. Twelve risk factors were assessed by the meta-analysis and grouped into two categories (patient related and procedure related). Significant patient-related factors for SSI included obesity, diabetes, ASA score, tobacco use and revision status. Procedure-related risk factors included operative time, use of osteotomy, fusion length and extension of fusion to the sacrum or pelvis.
Conclusions
This meta-analysis identified significant risk factors for SSI following spine arthrodesis. These included potentially modifiable factors such as obesity, diabetes, smoking status and procedure-related parameters. Non-modifiable risk factors were identified, including ASA score and age. These factors may prove useful for patient counseling as well as surgical planning.
Level of evidence
Level III (Meta-analysis including studies with a level of evidence of III or higher).
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
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What are the risk factors for surgical site infection after spinal fusion? A meta-analysis
verfasst von
Sebastien Pesenti Tejbir Pannu Jessica Andres-Bergos Renaud Lafage Justin S. Smith Steve Glassman Marinus de Kleuver Ferran Pellise Frank Schwab Virginie Lafage on behalf of the Scoliosis Research Society (SRS)
Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.
Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.
Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.
Update Orthopädie und Unfallchirurgie
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