PLIF术后手术部位感染发生影响因素的 Meta分析

Meta-Analysis of Influencing Factors for the Occurrence of Surgical Site Infection after PLIF

摘要: 目的：系统评价后路腰椎间融合术(posterior lumbar interbody fusion, PLIF)后患者发生手术部位感染的影响因素。方法：广泛检索了PubMed、Web of Science、Embase、Cochrane Library等国际知名数据库，以及中国知网、万方、维普等国内权威数据库，时间跨度自各数据库建立至2024年4月1日。由两名独立的研究人员分别进行文献的初步筛选和资料提取，采用Newcastle-Ottawa Scale (NOS)对纳入的文献进行质量评分，利用RevMan 5.4和Stata 15.1两款专业统计软件，我们对提取的数据进行了深入的Meta分析。结果：最终共纳入21项研究，涉及的总样本达13,257例。结论：后路腰椎间融合术后患者发生手术部位感染的独立危险因素包括年龄 ≥ 60岁(RR = 1.73, 95% CI: 1.27, 2.35)、手术时间 ≥ 3 h (RR = 2.37, 95% CI: 1.83, 3.08)、术后脑脊液漏(RR = 2.62, 95% CI: 1.29, 5.33)、糖尿病(RR = 1.97, 95% CI: 1.68, 2.30)、吸烟(RR = 1.50, 95% CI: 1.16, 1.95)、饮酒(RR = 1.51, 95% CI: 1.04, 2.19)、融合节段 ≥ 3个(RR = 2.65, 95% CI: 1.59, 4.43)、术后白蛋白水平 < 3.5 g/dl (RR = 3.35, 95% CI: 1.71, 6.56)、术前停留时间(RR = 1.13, 95% CI: 1.05, 1.21)。后路腰椎间融合术后患者发生手术部位感染的独立保护因素为男性(RR = 0.69, 95% CI: 0.52, 0.92)。

Abstract: Objective: To systematically evaluate the influencing factors of surgical site infection in patients after posterior lumbar interbody fusion (PLIF). Methods: We searched PubMed, Web of Science, Embase, Cochrane Library and other internationally renowned databases, as well as domestic authoritative databases such as CNKI, Wanfang, and VIP, from the establishment of each database to April 1, 2024. Two independent researchers conducted preliminary screening and data extraction, Newcastle-Ottawa Scale (NOS) was used to score the quality of the included studies, and RevMan 5.4 and Stata 15.1 were used to conduct in-depth Meta-analysis of the extracted data. Results: A total of 21 studies were included, with a total sample of 13,257 cases. Conclusion: Independent risk factors for surgical site infection in patients after posterior lumbar interbody fusion include age ≥ 60 years (RR = 1.73, 95% CI: 1.27, 2.35), operative time ≥ 3 hours (RR = 2.37, 95% CI: 1.83, 3.08), postoperative cerebrospinal fluid leak (RR = 2.62, 95% CI: 1.29, 5.33), diabetes mellitus (RR = 1.97, 95% CI: 1.68, 2.30), cigarette smoking (RR = 1.50, 95% CI: 1.16, 1.95), alcohol consumption (RR = 1.51, 95% CI: 1.04, 2.19), fusion segments ≥ 3 (RR = 2.65, 95% CI: 1.59, 4.43), postoperative albumin level < 3.5 g/dl (RR = 3.35, 95% CI: 1.71, 6.56), and length of stay before surgery (RR = 1.13, 95% CI: 1.05, 1.21). Male sex was an independent protective factor for surgical site infection after posterior lumbar interbody fusion (RR = 0.69, 95% CI: 0.52, 0.92).