Prevalence of Osteosynthesis Hardware Removal Due to Surgical Site Infections Following Sagittal Split Osteotomy: A Systematic Review and Meta-Analysis.

Abstract

Background/Objectives: Sagittal split ramus osteotomy (SSRO) is a commonly performed procedure in orthognathic surgery. Despite its effectiveness, surgical site infections (SSI) represent a significant postoperative complication, often necessitating the removal of osteosynthesis materials. This study aims to quantify the prevalence of hardware removal due to SSI following SSRO highlighting its impact on clinical outcomes. Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. Databases including Medline/PMC Central, Scopus, and Web of Science were searched up until 27 December 2024. Observational studies reporting osteosynthesis material removal due to SSI after SSRO were included. Data were extracted and analyzed using a random-effects model, calculating pooled prevalence and 95% confidence intervals (CI). Meta-regression was performed to explore potential predictors. Results: Twenty-nine studies published between 1992 and 2024 were included, encompassing 4489 patients. The pooled prevalence of osteosynthesis material removal due to SSI was 1.9% (95% CI: 0.7-3.4%), with substantial heterogeneity (I² = 87%). Meta-regression demonstrated that the mean age of patients was significantly associated with the prevalence of osteosynthesis hardware removal due to SSI. On the other hand, no significant association was demonstrated between the year of publication, the proportion of males, or the mean age with the prevalence of removal. Conclusions: SSI following SSRO clearly impacts patient outcomes and healthcare resources, while removal of osteosynthesis materials is often required. The substantial heterogeneity among studies included in the present systematic review may point to variability in patient characteristics, surgical techniques, and healthcare practices. The present findings underscore the importance of standardized prevention protocols and targeted management strategies. Future research should focus on understanding microbial profiles, patient-specific risk factors, and innovative surgical approaches to minimize SSI risks and improve patient outcomes.