Analysis of influencing factors of incision infection in combined anterior-posterior surgery for subaxial cervical fracture dislocation

Background: To explore the impact of related factors on the surgical site infection (SSI) after combined anterior-posterior surgery for subaxial cervical fracture dislocation (SCFD), and to provide a basis for formulating preventive measures.Methods: A total of 841 patients (531 males and 310 females, aged 24-68 years) with SCFD who received combined anterior-posterior surgery from January 2014 to May 2018 were retrospectively analyzed. According to whether the postoperative SSI occurred, they were divided into two groups. Demographic data, American spinal injury association (ASIA) neurological impairment scale, comorbidity, diet nursing and operating room related factors (time interval from skin preparation to operation, whether preoperative urinary catheterization was performed, whether was the consecutive operation, the total number of person in the operating room, operating room temperature, relative humidity, operational duration, and whether there was an intern nurse involved in the operation) the of patients in the two groups were analyzed by Logistic regression for the factors related to perioperative SSI. Result: SSI occurred in 44 patients with the rate of 5.2% (44/841). The results of univariate analysis showed that there were statistically significant differences between the two groups in the grade of ASIA scale, diabetes, lack of dietary care, time interval from skin preparation to operation, preoperative urinary catheterization, consecutive operation and the total number of person in the operating room (all P<0.01). Multivariable Logistic regression analysis results show that the severity of spinal cord injury (grade A OR value = 78.431, grade B OR value =24.120, grade C OR value = 5.342, P < 0.05, respectively), diabetes (OR value = 3.114, p=0.014), lack of dietary care (OR value = 2.275，p=0.023), time interval from skin preparation to operation > 6h (OR value = 2.342, p=0.022), preoperative urinary catheterization (OR value = 4.476, P <0.001) and the total number of person in the operating room > 8 (OR value = 2.921, P = 0.014) were positively correlated with perioperative SSI. Conclusion: The severity of spinal cord injury (ASIA grade A,B and C), diabetes, lack of dietary care, time interval from skin preparation to operation > 6 hours, preoperative urinary catheterization and the total number of person in the operating room > 8 are the risk factors for SSI after combined anterior-posterior surgery for SCFD.