Risk factors, diagnosis, and management of postoperative spinal surgical site infections: a retrospective analysis of 36 cases

Purpose: Postoperative spinal surgical site infections (SSIs) significantly impact patient morbidity, healthcare costs, and recovery. This study aimed to identify risk factors and diagnostic indicators and discuss the treatment modalities for spinal SSI through retrospective analysis. Materials and methods: Data from 36 patients with spinal SSI, operated between January 2014 and January 2018, were retrospectively evaluated. Patient-related and surgery-related risk factors, clinical presentations, laboratory findings, microbiological cultures, radiological imaging, and treatment outcomes were analysed. Results: Among 2,596 spinal surgeries, 36 SSIs (1.39%) occurred. Common risk factors included hypertension, diabetes, coronary artery disease, immunosuppression, and smoking. Early-onset infections (<30 days; 72.2%) presented primarily with wound discharge; late-onset infections (>30 days; 27.8%) were characterised by persistent pain. CRP and neutrophil-to-lymphocyte ratio (NLR) were found to be important diagnostic markers. Culture positivity was higher in early-onset infections; Escherichia coli was the predominant pathogen. Deep infections required longer antibiotic therapy and hospital stay (p<0.05). Multidisciplinary management—including surgical debridement, irrigation, vacuum-assisted closure, and hyperbaric oxygen therapy—was essential. Despite aggressive treatment, five patients succumbed to complications. Conclusion: Meticulous risk assessment, early diagnosis using NLR and CRP, culture-guided antibiotic therapy, and individualised multidisciplinary strategies remain crucial for managing spinal SSIs effectively.