Risk factors for surgical site infection following pediatric spinal deformity surgery: a systematic review and meta-analysis

This study was conducted to identify risk factors for postoperative infection after pediatric spinal deformity surgery. A systematic electronic literature search from inception to November 2014 was performed in the following databases: Pubmed, Embase, and Cochrane library databases. Pooled odds ratios (ORs) or standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were calculated using random or fixed effects model. Newcastle-Ottawa scale was used to evaluate the methodological quality, and Stata 11.0 was used to analyze data. The main factors associated with infection after spinal surgery were idiopathic scoliosis (OR, 0.303; 95 % CI, 0.202-0.453), neuromuscular scoliosis (OR, 2.269; 95 % CI, 1.576-3.267), ambulatory status (OR, 0.241; 95 % CI, 0.078-0.747), previous spinal surgery (OR, 4.564; 95 % CI, 1.892-11.009), sacral vertebrae fused (OR, 2.717; 95 % CI, 1.836-4.020), and allograft (OR, 8.498; 95 % CI, 4.030-17.917). There was no sufficient evidence to reveal that male gender, age, body mass index, preoperative curve, preoperative urinary tract infection, combined anterior-posterior approach, estimated blood loss, and operating room time could lead to infection after spinal surgery. We identified some risk factors which could be used to prevent the onset of surgical site infection in pediatric spinal deformity surgery. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among the studies.