Risk factors for surgical site infection after open transforaminal lumbar interbody fusion in treating degenerative lumbar diseases

Open transforaminal lumbar interbody fusion (O-TLIF) is an acknowledged surgical technique for addressing lumbar degenerative diseases. Postoperative surgical site infections (SSIs) can occur. This study aims to identify the independent risk factors for SSIs following O-TLIF in the treatment of lumbar spinal stenosis. A cohort of 1000 patients who underwent O-TLIF for lumbar spinal stenosis between 2013 and 2019 in our hospital was studied. These patients were divided into 2 groups: the infection group (n = 23) and the non-infection group (n = 977). Demographic, surgical, and radiological data were prospectively recorded to investigate the independent risk factors for SSI. Quantitative data were expressed as x ± s and analyzed using the independent sample t test; categorical data were presented as frequency (percentage) and compared using the chi-square test. Both univariate and multivariate logistic regression analyses were utilized to evaluate the significance of potential risk factors, and line charts and receiver operating characteristic curves were generated. The SSI occurrence rate in patients undergoing O-TLIF was 2.3% (23/1000). Multifactorial regression analysis identified older age (odds ratio [OR], 1.073; 95% confidence interval [CI], 1.020-1.129; P = .006), longer surgical duration (OR, 1.008; 95% CI, 1.002-1.013; P = .009), greater intraoperative blood loss (OR, 1.001; 95% CI, 1.000-1.002; P = .030), smoking (OR, 3.149; 95% CI, 1.278-7.758; P = .013), and diabetes (OR, 3.914; 95% CI, 1.513-10.127; P = .005) as independent risk factors for postoperative infection. The area under the curve values for age, surgical duration, intraoperative blood loss, diabetes, and smoking in predicting postoperative infection were 0.754 (0.658-0.849) (P < .001), 0.743 (0.627-0.860) (P < .001), 0.692 (0.569-0.814) (P = .002), 0.654 (0.528-0.780) (P = .012), and 0.622 (0.503-0.741) (P = .045), respectively. The optimal cutoff values were 67.5 years for age, 156 minutes for surgical duration, and 475 mL for intraoperative blood loss. Advanced age, smoking, prolonged surgical duration, diabetes, and increased intraoperative blood loss serve as independent risk factors for SSI following O-TLIF. Patients above 68 years old, with surgical durations exceeding 156 minutes, intraoperative blood losses surpassing 475 mL, those with diabetes, and smokers are at significant risk for SSI after lumbar surgery.