Does Intraoperative Anal Area Covering Affect the Incidence and Causative Organisms of Surgical Site Infection After Posterior Lumbosacral Fusion Surgery?

Abstract

This study investigates the impact of intraoperative anal area coverage on the incidence and causative organisms of surgical site infections (SSIs) following posterior lumbosacral fusion surgery. A retrospective analysis was conducted on 1226 patients who underwent posterior lumbosacral fusion surgery. Patients were divided into 2 groups based on whether intraoperative anal area coverage was used. SSI rates, pathogen profiles, and perioperative parameters were recorded and compared between groups. Multivariable regression analysis was performed to assess the impact of intraoperative anal area coverage and other factors (e.g., body mass index, intraoperative blood loss, drainage volume) on SSI incidence. The findings demonstrate a significant reduction in the incidence of SSIs in the group where the anal area was covered during surgery. Additionally, the causative organisms differed between the covered and uncovered groups, with a lower incidence of gram-negative bacteria from gastrointestinal and urinary sources in the covered group. Multivariable regression analysis identified several factors associated with the incidence of SSIs following posterior lumbosacral fusion surgery. Intraoperative anal area coverage was significantly associated with a reduction in SSI rates (β = -0.85, 95% confidence interval: -1.55 to 0.15, P = 0.024), indicating a protective effect. Body mass index (β = 0.15, P = 0.045), intraoperative blood loss (β = 0.01, P = 0.039), and drainage volume (β = 0.10, P = 0.018) were also significantly associated with increased SSI risk. Age and surgery duration were not statistically significant factors. Intraoperative coverage of the anal area appears to be an effective measure in reducing the incidence of SSIs following posterior lumbosacral fusion surgery. This practice also alters the microbial landscape, reducing the prevalence of gram-negative bacteria associated with gastrointestinal and urinary tracts, thereby improving infection prevention strategies.