Modulation of Surgical Site Infection Risk in Spinal and Thoracic Surgeries Through Operative Parameters: A Narrative Review

Abstract

Background: Surgical site infections (SSIs) following spinal and thoracic procedures are associated with prolonged hospitalization and increased morbidity, with incidence rates of 2–15% in spinal surgery and 3–12% in thoracic procedures. Multiple patient-related and procedure-specific factors contribute to wound complications, including diabetes mellitus, obesity, smoking, extended surgical time, excessive tissue dissection, and hardware implantation. Implementing evidence-based prevention and early intervention strategies is essential in high-risk surgical cohorts. Methods: This narrative review followed searches in PubMed, Scopus, ScienceDirect, Cochrane Library, and Embase for studies published between January 2000 and October 2025. Eligible peer-reviewed articles examined SSI incidence, risk factors, or prevention strategies in adult patients undergoing thoracic or spinal surgery. Data extraction focused on operative parameters, antibiotic prophylaxis regimens, negative-pressure wound therapy (NPWT) use, and patient outcomes. Results: Evidence from found recent studies was synthesized. Key findings demonstrated that operative duration > 4 h increased SSI odds by 41% per additional hour, and blood loss > 500 mL doubled infection risk. Prophylactic NPWT reduced deep SSI rates by 50% in high-risk patients (BMI ≥ 35, diabetes, multilevel instrumentation). Intrawound vancomycin powder reduced deep SSIs by 50–60%, particularly in multilevel fusions. Administering prophylactic antibiotics within 30 min of incision was significantly more effective than at 60 min, with a 23% relative risk reduction. Weight-adjusted antibiotic dosing in obese patients lowered SSI rates from 5.1% to 2.9%. Conclusions: Operative parameters strongly predict SSI risk. An integrated risk- and evidence-based approach to wound management following spinal and thoracic surgeries—combining optimized antibiotic prophylaxis, risk-stratified NPWT application, and operative technique modifications—can significantly reduce SSI incidence. Successful implementation requires institutional commitment, multidisciplinary collaboration, and continuous quality improvement to optimize patient outcomes.