Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy

Abstract

Recently, we were honoured to read Dr. Xiao et al.'s ‘Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy’. This study retrospectively analysed the clinical data of 335 patients with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) and concluded that high BMI, diabetes, long-term use of corticosteroid, long operation time and cerebrospinal fluid leakage were independent risk factors for SSI.¹ We are very grateful for the author’s contribution in this field, but there are still some problems in this study that need to be further explored.

First, although this study explored that long-term use of corticosteroids before surgery increased the incidence of SSI after PELD, the concept of long-term use of corticosteroids was not defined. A meta-analysis of whether long-term preoperative corticosteroid use affects the outcome of orthopaedic surgery included patients who required regular oral or parental corticosteroid therapy for chronic diseases within 30 days before surgery, excluding patients who received a limited short-term course of treatment (≤10 days) or took topical, inhaled and rectal steroids.² Secondly, this study lacks a discussion on whether preoperative local injection of corticosteroids will affect the incidence of SSI. It has been reported that local injection of corticosteroids within 4 months before surgery will increase the risk of postoperative periprosthetic infection and surgical site infection.³ Interestingly, in addition to the various factors discussed by the authors, environmental factors also have an impact on the incidence of postoperative SSI. Spinal surgery performed in the warm season has a higher incidence of SSI.⁴ The reason for this phenomenon may be that posterior surgery causes poor ventilation of the patient's incision and bacteria are easy to breed in warm and humid environments.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.