Risk factors for surgical site infections after orthopaedic surgery: A meta-analysis and systematic review

Abstract

The objective of this meta-analysis was to investigate the occurrence and determinants of surgical site infections (SSIs) in individuals following orthopaedic surgical procedures. A systematic exploration of articles concerning factors predisposing individuals to SSIs after orthopaedic surgery was conducted across multiple databases, including PubMed, Embase, Cochrane Library and Web of Science, up to March 20, 2024. The Stata 15.0 software was employed to estimate combined odds ratios (ORs) utilizing either a random-effects model or a fixed-effects model based on the degree of heterogeneity among the included studies. Egger's test was used to assess publication bias. Among the 1248 records retrieved, 45 articles were deemed eligible after screening for studies incorporating multivariate analyses of risk factors associated with SSIs. These comprised four case-control studies and 41 cohort studies, collectively involving 1 572 160 patients, among whom 43 971 cases of SSIs were reported postoperatively. Meta-analysis outcomes indicated significant associations between SSIs and the following factors: low Albumin levels (<35 g/L; OR = 2.29, 95% confidence interval [CI]: 1.45-3.62, p = 0.0001), ASA score >2 (OR = 2.32, 95% CI: 1.86-2.89, p = 0.0001), elevated body mass index (BMI) (>24 kg/m²) (OR = 2.15, 95% CI: 1.60-2.90, p = 0.0001), diabetes (OR = 2.25, 95% CI: 1.66-3.05, p = 0.0001), prolonged surgical duration (>60 min) (OR = 2.06, 95% CI: 1.52-2.80, p = 0.001), undergoing multiple surgeries/procedures (OR = 2.38, 95% CI: 1.29-4.41, p = 0.006), presence of an open fracture (OR = 3.35, 95% CI: 2.51-4.46, p = 0.001), current smoking (OR = 2.87, 95% CI: 1.88-4.37, p = 0.0001), higher wound class (>2; OR = 3.59, 95% CI: 1.68-7.66, p = 0.001) and utilization of implants (OR = 1.89, 95% CI: 1.15-3.11, p = 0.0012). The present study identified a number of risk factors for the development of SSIs following orthopaedic surgery. It is therefore recommended that clinicians closely monitor these indicators in order to prevent the development of postoperative SSIs. Furthermore, our interpretation of diabetes mellitus was not adequate. It is therefore recommended that future studies refine the effect of diabetes mellitus on SSIs in different situations.

Keywords: infection; orthopaedic surgery; orthopaedics; risk factors; surgical site infection.