The role of environmental and seasonal factors in spine deep surgical site infection: the air pollution, a factor that may be underestimated.

Abstract

Different strategies have been described in order to reduce spine deep surgical site infection (SSI); however, non-intervenable items such as environmental factors remain as one of the main concerns for spine surgeons. A retrospective cohort study was designed in order to evaluate the effect of environmental factors such as temperature, humidity and particularly the air pollution index (PM 2.5) on spine surgical site infection. The files of 3609 patients who underwent spinal surgery from April 2019 to March 2022 were reviewed, and 121 patients with spine SSI were detected. There was no significant relationship between mean temperature and humidity of each month with infection and type of bacteria. However, there was a significant relation between warmer season periods and infection. The rate of infection among patients was 3.25% ranged from 2.5% to 4% in colder and warmer seasons accordingly. It was determined that air pollution had a significant relationship with the infection and the type of bacteria. (p value < 0.05, R-Squared = 0.249). Our study revealed a 60% increase in spine SSI during warmer seasons. There was a significant correlation between air pollution and the rate of infection. These may suggest the necessity to reduce the number of elective spine surgeries during warmer seasons and when the level of air pollutant is high.