| Background:At present,it has been reported that many different pathogenic factors can lead to infection at the site of spinal surgery(Surgical site infection,SSI),mainly in the following three aspects: preoperative pathogenic factors,surgical-related pathogenic factors,postoperative pathogenic factors.However,the existing research results have great differences in the correlation between different pathogenic factors and infection at the site of spinal surgery,and there is controversy about the correlation between some pathogenic factors and SSI.The correlation between some pathogenic factors and infection at the site of spinal surgery are even opposite in different research literature.in view of the fact that SSI can cause more serious complications after spinal surgery,such as internal fixation failure,fusion failure,intraspinal infection and even intracranial infection.Therefore,it is particularly important to study the correlation between different pathogenic factors and SSI after spinal surgery.Objective:The method based on meta analysis systematically evaluated the correlation between different pathogenic factors and SSI after spinal surgery,and provided evidence-based medical evidence for clinical work.Methods:All SSI-related pathogenic factors related to spinal surgery were retrieved from 8 databases,Pubmed,Science,Embase,Cochrane,CNKI,VIP,Wanfang and CBM,which were established until September 30,2018,by means of computer system.The combination of subject words and free words is supplemented by manual retrieval of relevant citations,and the retrieval language is limited to English and Chinese.According to the set inclusion and exclusion criteria,the literature which was finally included in the study was obtained.after incorporating the literature quality evaluation,the data were extracted and Meta analysis was carried out by Revman5.3 software.Result:A total of 23 studies were included in this study,including 16113 patients with spinal surgery,including 599 patients with surgical site infection,the overall infection rate of the sample was 3.72%.The results of Meta analysis showed that male,[OR= 1.33,95%CI(1.08,1.57),P=0.005],age>60 years[OR=2.43,95%CI:1.83-3.23,P<0.00001],BMI> 30 [OR=4.92,95%CI:2.18-11.12,P=0.00001],smoking[OR=1.47,95%CI: 1.13-1.92,P=0.004],diabetes [OR=2.96,95%CI:2.37-3.69,P<0.00001],hypertension [OR=1.64,95%CI:1.16-2.31,P=0.005],NNIS score>1 [OR= 2.63,95%CI:1.23-5.63,P=0.01],preoperative albumin < 35g/L [OR= 2.63,95%CI:1.23-5.63,P=0.01],operation time?3h [OR= 3.40,95% CI: 2.40-4.81,P<0.00001],operation segment?3 [OR=8.13,95%CI:2.67-24.76,P=0.0002],Intraoperative blood loss ? 1000 ML [OR =3.08,95% CI:1.82-5.23,P<0.00001],cerebrospinal fluid leakage [OR= 1.92,95% CI:1.27-2.92,P=0.002],allogeneic bone graft [OR=2.90,95%CI:1.14-7.38,P=0.03],blood transfusion [OR=3.17,95%CI:1.91-5.28,P<0.00001],mean drainage time [OR=0.27,95%CI:0.07-0.46,P=0.007],discontinuous suture of deep fascia [OR=5.62,95%CI:2.52-12.52,P<0.00001] were correlated with SSI after spinal surgery.The second operation [1.85,95% CI:0.98-3.48,P=0.06],steroid hormone use history [OR= 0.89,95% CI:0.51-1.55,P=0.68],ASA score>2[OR=2.24,95%CI:0.79-6.37,P=0.13,internal fixation [OR=1.54,95%CI:0.79-3.00,P=0.21],postoperative admission to ICU [OR=2.54,95%CI:0.47-13.63,P=0.28] were not correlated with SSI after spinal surgery.Conclusion:1.Based on the available research data,Male,age>60 years,BMI>30,smoking,diabetes,hypertension,NNIS score> 1,preoperative albumin<35g/L,operation time?3h,operation segment?3,intraoperative blood loss?1000ML,cerebrospinal fluid leakage,allogeneic bone graft,Blood transfusion,mean drainage time and intermittent suture of deep fascia were correlated with SSI after spinal surgery.2.According to the analysis of available research data,there is not enough evidence to prove that secondary surgery,steroid hormone application history,ASA score>2,the use of internal fixation,postoperative admission to ICU were correlated with SSI after spinal surgery. |
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